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; LIBRARY OFCONGRESS. 

ShelfU2z<?3 



UNITED STATES OF AMERICA. 



HANDBOOK 



OF 



EMERGENCIES 



AND 



COMMON AILMENTS. 



EXPLAINING THE LATEST APPROVED TREATMENT OF IN- 
JURIES, SUDDEN AND PAINFUL ATTACKS, POIS- 
ONING, AND MAJiY COMMON DISEASES. 



~f* ^^ BY 

E. F. BRADFORD, A. B., M. D., 

(HARVARD) 

MEMBER OF THE AMERICAN MEDICAL ASSOCIATION, 

FELLOW OF THE AMERICAN ACADEMY OF MEDICINE. 

ASSISTED BY , 

LOUIS LEWIS, M.D., 

MEMBER OF THE ROYAL COLLEGE OF SURGEONS, ENG., ONE OF THE EDI- 
TORS OF THE (MEDICAL) TIMES AND REGISTER, PHILADELPHIA, 
TOGETHER WITH OTHER WRITERS ON 
SPECIAL SUBJECTS. 



SOLD BY SUBSCRIPTION ONLY. 

BOSTON : \ 

B. B. RUSSELL. l/b~^7v *^ 



V x v 






JSntereo according to the Act of Congress, in the yea* 1892, by 

E. F, Bbadfobb. 
Id tkt Office o? the Librariac of Congress, at Washington. 1>. € 



PREFACE. 

The following pages have been written with the 
view of presenting to non-professional readers directions 
for the diagnosis and prompt treatment of a class of 
cases, such as the title-page sufficiently indicates. 
Several able and experienced physicians and surgeons, 
from different cities and parts of the country, have been 
selected to write upon subjects about which their line 
of study ana practice has made them especially well 
informed, and for the further purpose of giving variety to 
the language and views expressed. Besides this, the latest 
medical authorities have been freely consulted, in writing 
parts of the book. It is believed that the suggestions 
for treatment herein found are in accord with the 
latest and best practice of the medical art. 

The purpose of writing this book was partly sug- 
gested by these facts: Societies have been formed, of 
late, to give instructions in the prompt and proper treat- 
ment of persons injured or suddenly ill ; railroad com- 
panies have put into the hands of employees books of 



IV 

instruction in cases of emergency ; several books have 
been recently published in New York and Philadelphia 
on these subjects; these books seem too meagre in 
the amount of information given, to be of the greatest 
benefit. The plan of this book has been to treat the 
subjects more fully and extensively, and to describe in 
sufficient detail the latest remedies and methods of 
treatment — such as are available and easily understood. 
The science or art of medicine has no secrets which 
its practitioners seek to hide from the people, at least 
in these days of popular education; yet it is true 
that most persons are more easily deceived on the sub- 
ject of medicine, than upon almost any other of like im- 
portance. The authors have endeavored, not only 
to point out specific remedies for different ailments, 
but to discuss and explain some of the general principles 
upon which a sensible practice of medicine is founded. 
It is believed that, if the book is carefully studied, and 
the directions intelligently followed, it will be found of 
real use, and in certain cases, a respectable substitute 
for a medical man, when one is not easily obtained. 



CONTENTS. 

PART I. 

PAGE. 
A FEW INTRODUCTORY REMARKS: The Pulse. 

The Tongue. Respiration. Delirium. Inflammation. 
Symptoms and Signs of a Fever. Pain. Modes of 
Dying. Signs of Approaching Death. Are Diseases 
Cured without Medicine? Patent Medicines and Quack 
Doctors. A Medicine Case with Suggestions as to what 
it should contain. What Medicines are in the House. 7 

PART II. 

Injuries: Shock. Transportation of the In- 
jured. Hemorrhage, or Bleeding from Wounds, How 
to stop it. 

Wounds, their Modern Treatment. Incised 
Wounds. Punctured Wounds. Gunshot Wounds. 
Poisoned Wounds. Bites of Mad Dogs, and Hydropho- 
bia. Lacerated or Contused Wounds. Contusions. 
Mosquito Bites. Machinery and Railroad Injuries. In- 
juries of the Head. Fractures. Dislocations. Ban- 
daging. Sprains of Joints. Burns and Scalds. Sus- 
pended Animation. Artificial Respiration. Resusci- 
tation of the Apparently Drowned. Injuries from 
Lightning Stroke. Foreign Bodies in the Air Passages. 
Strangulation. Injuries from the Inhalation of Poison- 
ous Gases. Has Death Actually taken place? Signs of 
Death. Injuries from Severe Cold. Things in the Eye, 
Ear, Nose or Throat. Things Swallowed. Teeth 
Knocked Out. Sunstroke or Heat Stroke. Poisons 
and Poisoning. 55 

PART III. 
Sudden Attacks: Spasms, Fits and Convul- 
sions. Convulsions in Children. Inward Fits. Nine 
Day Fits. Child-Crowing. General Convulsions. Epi- 
lepsy. Hysterical Convulsions, or Fits. Catalepsy. 
Apoplexy. Congestion of the Brain. Fainting Fits. 
Dizziness. Palpitation of the Heart. 



VI 

Painful Attacks: Headaches. Sick-headache. 
Nervous Headache. Bilious Headache. Toothache. 
Earache. Faceache. Pain in the Neck. 

Pain in the Chest: Acute Pleurisy. Inter- 
costal Neuralgia. Muscular Rheumatism of the Chest. 
The Shingles. Spinal Irritation. Pain about the 
Heart. Angina Pectoris. Pneumonia. 

Pain in the Stomach : Gastritis. Gastralgia. 
Pyrosis. Intestinal Colic. Cholera Morbus. Stop- 
page. Inflammation of the Bowels. Strangulated Her- 
nia. Gall-Stones, or Hepatic Colic. Renal Colic. A 
Fit of Gravel. Painful Urinary Disorders. Muscular 
Rheumatism. Neuralgia. Acute Articular Rheuma- 
tism. Chronic Rheumatism. Acute Abscess. Felon, 
or Whitlow. Boils. Carbuncles. 161 

PART IV. 

Some Common Ailments : Taking Cold. Cold 
in the Head. Acute Pharyngitis. Acute Laryngitis. 
Acute Tonsillitis. Coughs and Colds. Acute Bronchitis. 
Chronic Nasal Catarrh. La Grippe, or Epidemic In- 
fluenza. Indigestion. Dyspepsia. Acute Indigestion. 
Constipation. Diarrhoea. Acute Dysentery. Hem- 
orrhage from the Lungs. Nosebleed. Asthma. An- 
aemia. Jaundice. Care of the Eyes and Ears. Sleep- 
lessness or Insomnia., 

Diseases of the Skin: Eczema. Acne. 
Psoriasis. Nettle-rash. Erythema. Erysipelas. Pruri- 
tus. Phthiriasis. The Itch. Ringworms. Rose-rash. 
Lichen. Herpes. Pityriasis. Skin-Cancer. Liver 
Spots. Ivy Poisoning. 244 

PART V. 
Diseases of Infancy and Childhood : Apho- 
risms. Sore mouth, or Stomatitis. Teething. The 
Contagious Diseases. Diarrhoea. Cholera Infantum. 
Indigestion. Constipation. Convulsions. Worms. 
Diseases of the Respiratory Organs, ere. 331 

Miscellaneous Subjects. 427 



HANDBOOK 



EMERGENCIES 



AND 



Common Ailments, 



PART I. 



A FEW INTRODUCTORY REMARKS. 

The majority of cases of sickness and injury are first 
treated, to some extent, by unprofessional hands, either 
properly or improperly. This must include a large class 
of cases of mild diseases and injuries, which are not 
considered sufficiently dangerous to require the expensive 
attendance of a physician, but which are treated by 
home-made skill, powerfully aided by that wise and in- 
expensive healer, Nature. 

This may be called the common school of medicine as 
distinguished from such well-known schools or systems 
of medicine as the Allopathic, Homoeopathic, Eclectic, 
and that last-born art of healing, Mind, Faith, or Chris- 
tian Science Cure, with their more or less learned prac- 
titioners. 

These common, diploma-less doctors outnumber by 



8 



HANDBOOK. 



hundreds those of any other school, for there is one or 
more in nearly every family. 

All kinds of medicine which the house or neighbor- 
hood affords, patent and proprietary medicines, pills and 
herb drinks, and whatever friends and old women pre- 
scribe, besides many whimsical remedies that tradition 
has handed down, make up the materia medica used in 
this common school of practice. 

That thousands of sick persons get well in time, if well 
nursed, when treated by "home talent "and simple 
medicines, cannot be denied. 

Whatever may be said for or against domestic prac- 
tice, it will continue to a greater or less extent by the 
necessity of circumstances, and it is of considerable 
importance. It seems desirable that it should come as 
near as possible to some scientific basis, and not be left 
to the control of superstition and ignorance. 

When a doctor is in attendance on a patient his visits 
are brief, and sometimes, like angels' visits, infrequent ; 
during all the remaining time the patient is left in charge 
of the family, who may, w r ith ignorant management, un- 
do all the good that his bitter medicine has accomplished. 

As a kind of preparatory course of instruction for this 
large class of amateur doctors, we introduce here some 
general information and practical hints upon subjects 
which, as the writer has reasons to believe, are not well 
understood by the average person. Certain rules and 
general principles regarding the diagnosis and treatment 
of common diseases are not difficult to be understood by 



A FEW INTRODUCTORY REMARKS. 9 

any person of ordinary intelligence, and should be useful 
to those who undertake, from choice or necessity, to 
nurse and prescribe for the sick or injured. 

We propose to call attention also to some excellent 
medicines and remedies which can be found in nearly 
every dwelling house, describe the virtues of each one, 
and point out the cases in which they will be found of 
great benefit when medicine is needed. 

Some of these remedies are so important that they are 
largely relied upon by physicians and surgeons them- 
selves, and are often the first called for in cases of injury 
and sudden sickness. 

The Pulse.* — It is the practice among doctors to 
notice carefully the stroke of the patient's pulse as the 
first thing in the physical examination. 

To examine the pulse, place the first two fingers on 
the inside and thumb side of the wrist, at which place, 
perhaps after a little searching, the beating artery may 
be felt. The pulse is owing to a wave of blood which is 
driven along the artery at each beat of the heart. 
The natural pulse rate in a 

Male adult is 65 to 80 a minute. 
Female adult is 75 to 90 a minute. 
Infant 6 months is 110 to 130 a minute. 
Child 12 years is 85 to 100 a minute. 

*According to experiments made in Paris, the pulse of a lion beats 40 timee 
a minute; that of a tiger 96 times; of a tapir 44 times; of a horse 40 times; of 
a dog52tiraes ; of a fox 43 times; of a bear 38 times; of a monkey 48 times; 
of an eagle 160 times. It was impossible to determine the beatings of an 
elephant's pulse. It was discovered that a butterfly's pulse was 60 a minute. 



10 HANDBOOK. 

Increased frequency of the pulse does not always 
indicate disease, but when acute inflammatory disease 
does exist the pulse is quickened. Exercise or excite- 
ment of any kind, and restlessness make the pulse un- 
naturally rapid. 

In great debility and weakness from any cause, the 
pulse is also increased in its frequency ; the more de- 
pressed the vital strength the higher the pulse rate be- 
comes. 

The strength or volume of the pulse is of more signifi- 
cance than its frequency. A strong pulse denotes that 
there is no failure at the heart, which is important, for 
in most fatal cases, the patient dies from heart failure. 

A very strong, full or bounding pulse is found in the 
first stages of nearly all fevers, and acute and sthenic 
inflammatory diseases. If the case advances favorably 
the pulse will become softer and not so full. 

A slow pulse is common in jaundice and apoplexy, in 
injuries to the brain and pressure upon it, in some dis- 
eases of the heart and liver, and in exposure to cold and 
wet. In some persons the pulse is always slow, 50 to 60. 

The pulse may be irregular, that is, the beats may be 
unequal in strength or some beats may be left out, mak- 
ing the intermittent pulse. 

An irregular and intermittent pulse in a person past 
the middle age, indicates that the heart is diseased, 
especially if the patient is short of breath on exercising. 
There are exceptions to this rule ; for instance, in certain 



A FEW INTRODUCTORY REMARKS. 11 

cases of dyspepsia and nervous prostration, this kind of 
pulse is noticed. The patient's pulse is sometimes inter- 
mittent in brain disease, and after taking large doses of 
morphine. An irregular and intermittent pulse does not 
always indicate great danger from heart disease, for per- 
sons have lived many years having this kind of a pulse. 

In most cases of apoplexy the pulse is full and bound- 
ing, and usually slow — valuable signs in confirming a 
a diagnosis of the disease. 

A pulse which is frequent and changeable in its 
rhythm, points out the probable existence of a disease 
of the heart or brain, or when noticed after protracted 
and wasting disease, it signifies that the patient is about 
to die from heart failure. 

In nearly all the fevers the pulse is at first full and 
strong, and the increase in frequency keeps pace with 
the rise of temperature, but there is nothing very distinc- 
tive about this, for in a severe attack of a common cold 
or bronchitis, the pulse is almost equally full and strong 
at first. Local inflammation, if severe, may affect the 
pulse in a similar manner, thatis, increase its fulness and 
frequency. 

By the term "full pulse " we mean that the beat of the 
artery is large — that the artery is filled with blood at 
every beat of the heart; a pulse much more common in 
the young and robust, than in the old and feeble in 
health or disease. 4 

A hard tense pulse denotes that the blood is being 
driven with unusual force through the arteries and gen- 



12 HANDBOOK. 

erally means that active and violent inflammation is 
going on in some part of the body. 

Just the opposite of this is the soft and compressible 
pulse which is found in low fevers and in debility, but 
when it follows the hard tense pulse it denotes that the 
crisis has passed and the patient on the road to re- 
covery. 

A very rapid, soft and compressible pulse in the late 
stages of acute or chronic diseases indicates great clanger, 
if other unfavorable symptoms are present. 

A small, tense and quick pulse, feeling like a small 
wire vibrating under the ringers, is very peculiar and 
sometimes met with in inflammation of the bowels and in 
peritonitis. 

Excepting in some cases of sudden and violent death, 
the pulse of the dying becomes what is called a thready 
pulse, that is, it is very small, rapid, soft and compress- 
ible, feeling like a small thread feebly vibrating under 
the examining fingers. 

The pulse of children is exceedingly variable ; fatigue, 
violent exercise, or mental excitement may make the 
pulse as rapid as it is in disease. 

The Tongue. — It is the practice to examine the 
patient's tongue as well as the pulse. What information 
does its appearance afford? Some things regarding the 
nature, severity and progress of a disease. 

Some persons in fair health have a furred tongue in 
the morning, which becomes cleaner before night ; gen- 



A FEW INTRODUCTORY REMARKS. 13 

erally this indicates some unhealthy condition of the 
stomach or bowels. 

In fevers and other diseases, if the coating is white, 
uniform, moist, and not very thick, it may be regarded 
as a favorable sign, but when the fur is thin, scanty and 
adhesive, allowing redness to appear through it, and 
inclined to become dry, the case will have a more un- 
favorable aspect. 

The manner in which a furred tongue cleans is sig- 
nificant. When the coating slowly leaves the tip and 
edges, a healthy color appearing underneath and natural 
moisture returning, it may be known that the patient is 
improving ; but when the fur loosens and separates in 
patches, beginning in the center or at the roots of the 
tongue, leaving a red, glossy appearance, convalescence 
will probably take place, but slowly. 

In the diseases of aged people, a raw, dry and cracked 
looking tongue is of rather bad omen, and if in the later 
stages of the disease, canker also appears in the mouth 
and on the tongue, the case will be still more discourag- 
ing. 

A pale tongue, if at the same time the skin, the lips 
and the lining membrane of the mouth are pale, indicates 
that the person is anaemic, that the blood is in a poor 
and watery condition, and deficient in red globules. 

The tongue is dry in high fevers, in inflammations of 
the stomach and bowels, and in all very severe inflamma- 
tions. It is a favorable sign, and generally signifies that 



14 HANDBOOK. 

the crisis has passed, when, after this dry condition, it 
grows moist. 

The strawberry tongue, so called, is peculiar to cases 
of scarlet fever. The tongue is often very red if in- 
flammation attacks the throat, or in tonsillitis it is covered 
with a thick, creamy coat. 

To sum up the manifestations afforded by the tongue 
which indicate danger are : tremulous action ; dry- 
ness ; a livid color ; a very red, shining, or raw aspect ; 
a marked fur or a heavy coating of a dark or black hue. 
Any change from these to a more natural look bears a 
favorable interpretation. 

Respiration or Breathing is changed, to a greater 
or less extent, in different diseases and is a symptom of 
some significance. 

Physicians in recording a case note the temperature, 
the pulse, and number of respirations a minute. 

An adult in good health, when quiet, breaths from 16 
to 20 times a minute. In all feverish conditions and in 
acute inflammatory disease, the breathing is increased in 
frequencj 7 , and as long as it is, the patient is not im- 
proving, but if it begins to fall towards the natural rate, 
convalescence may be expected. This is very noticeable 
in the ailments of children. 

The breathing may be so slow and shallow in cases of 
narcotic poisoning, hysteria, trance, shock, poisoning 
from noxious gases, and in injuries of the brain, that an 
ordinary observer would 'think the patient was dead. 



A FEW INTRODUCTORY REMARKS. 15 

In cases of drowning, the breathing is so obstructed 
that artificial respiration is the only means of saving life. 

There may be restrained breathing ; the patient makes 
an effort to hold back the breath, because it is painful ; 
this is noticed in pleurisy, peritonitis, etc. 

Difficult breathing is called in technical language, 
dyspnoea, and is a conspicuous symptom in many dis- 
eases ; in asthma, tonsillitis, congestion of the lungs, 
suffocative catarrh, etc. 

Shortness of breath in walking and going up stairs or 
any unusual effort is sometimes the first thing that calls 
one's attention to the fact that his health is below par. 

It may point to anaemia, general debility, disease of 
the heart or chronic lung disease, etc., as the cause 
excepting in the case of corpulent persons who are nat- 
urally a little short of breath. 

Delirium is a wandering of the mind. It occurs most 
frequently in those of a susceptible nervous system, and 
is consequently more common in the young. It is an 
alarming symptom to most persons inexperienced in 
sickness, but it is not necessarily of a bad meaning. 
Many mothers fear because their children are delirious 
that they have a disease of the brain. Such a fear is 
not generally well founded, for thousands of sick children 
are delirious with slight ailments. 

Some adults are delirious at first with a common cold 
or some other mild disorder, but generally, if in adults, 



16 HANDBOOK. 

delirium continues, it is a symptom that some serious 
disease exists, except in the hysterical. 

Delirium is a conspicuous symptom in typhoid fever, 
but not common in pneumonia or lung iever but may be 
present. At the onset of nearly all high fevers and 
severe inflammatory diseases, more or less delirium is 
noticeable and is owing to the congestion or fulness of 
blood in the brain. This kind is transient. It is most 
common when the patient first wakes from sleep. 

In nearly all diseases of the brain the patient is 
delirious. 

Inflammation plaj^s such an important part in the 
majority of diseases and injuries and is so often referred 
to in all medical books, that a little account of it will 
help the understanding of the reader. 

Inflammation forms the chief source of danger in most 
serious diseases and injuries ; the aim of treatment is 
generally to cure or to allay the inflammation of a part 
or of an organ. 

Medical words are so formed as to make easy refer- 
ence to it ; for instance, bronchitis means an inflamma- 
tion of the bronchial tubes, tonsillitis, an inflammation 
of the tonsils, gastritis, inflammation of the stomach 
(from gaster, the stomach) , and that numerous class of 
medical words ending in " itis " generally means an in- 
flammation of the part. 

Just what inflammation is, nobody knows. The 
ancients thought it was fire because there was heat and 



A FEW INTRODUCTORY REMARKS. 17 

redness. The signs of inflammation seen externally are 
easily recognized ; they are four, viz : heat, redness, pain 
and swelling. There is always at first a congestion or a 
rush of blood to an inflamed part, which mostly accounts 
for these signs. 

When inflammation is quite severe it produces fever- 
heat of the body, and the patient then has symptomatic 
fever, so called. There are four different ways in which 
inflammation of a part may result or terminate. 

1. In recovery or resolution, to use the surgeon's word. 

2. In abscess or suppuration. 

3. In mortification or death of the part. 

4. In death of the patient. 

When recovery takes place, the inflammatory products 
are absorbed. If the inflammation continues to a cer- 
tain extent the tissues soften and pus (or matter) is 
formed. 

It is a well known fact to all surgeons that wounds 
are attended with more or less inflammation ; if quite 
mild it soon ends in resolution, if sufficiently severe it 
ends in suppuration or the formation of matter. Most 
running sores and ulcers are the results of previous in- 
flammation. 

The chronic form is a slow process which may last 
weeks ; the tissues sometimes become hardened, or what is 
called a cold or indolent abscess may form. In measles, 
scarlet fever, erysipelas and most of the humors or skin 
diseases, inflammation of the skin is a factor of the 
trouble. What is called catarrhal inflammation, signi- 



18 HANDBOOK. 

fying an inflammation of the lining membranes of the 
body, the inner skin, makes a large number of diseases, 
such as nasal catarrh, gastritis, dysentery, inflammation 
of the bowels, catarrh of the kidneys and bladder, peri- 
tonitis, inflammation of the bile passage, (jaundice), 
pleurisy, sore throat, and so on. 

It so happens that for the first treatment of external 
inflammation, nothing has yet been discovered which is 
so good as the common household remedy, very hot or 
ice cold water, which ever seems to agree best with the 
patient. It has a soothing effect upon the red and angry 
tissues and irritated nerves, thus preventing pain and 
swelling, and relieving the congestion. Poultices aet on 
the same principle as hot water. 

Symptoms and Signs of a Fever. — The following 
is a train of symptoms called the fever symptoms. In 
the forming stage there are premonitory symptoms lasting 
a longer or shorter time ; there is great diversity about 
their duration. A sense of heaviness with yawning and 
stretching and a general feeling of discomfort which can 
not be referred to any particular part ; the muscles feel 
tired and sore as if they had been pounded ; there is of- 
ten depression of spirits and disturbed sleep. The first 
real fever symptom is usually a chilly or shivering feel- 
ing, sometimes a real chill in adults. One or more con- 
vulsions in children sometimes take the place of a chill. 
During this chilly stage the skin is cold to the touch. 
" The outer parts freeze, while the inner burn. " In this 



A FEW INTRODUCTORY REMARKS. 19 

cold stage the pulse may be unnaturally slow. Heat, 
redness of the skin, and thirst soon follow these chilly 
sensations. The pulse becomes full and frequent ; the 
breathing is hurried ; there is headache, pain in the back 
and limbs. The tongue is furred. The urine is scanty 
and high colored and constipation as a rule exists. Gen- 
erally there is entire loss of appetite, the patient wanting 
nothing but cold water. 

Now-a-days doctors use a fever thermometer which 
accurately marks the degree of fever and depend less 
upon the patient's other symptoms in deciding whether 
he has a fever. 

The natural temperature of the body is 98 1-2° Fr. 

Moderate fever heat is 100° to 103° Fr. 

High fever heat is 104° to 106° Fr. 

When the temperature continues 24 hours at 106 Q the 
patient is usually in imminent danger unless it is owing 
to malarial fever. 

It should be remembered that although these are the 
fever symptoms they are not always followed by what we 
call a real fever, for instance, a severe cold, an inflamma- 
tion of an internal organ or of some external part, and 
many other ailments are preceded by the same symptoms. 

Each particular fever hns its marks or signs by which 
it is distinguished. Typhoid fever comes on slowly, usu- 
ally with diarrhoea, tenderness of the bowels, persistent 
headache, loss of appetite etc. Scarlet fever is sudden 
in its attack, beginning with vomiting, sore throat, high 
fever and at the end of 24 hours a scarlet rash appears. 



20 HANDBOOK. 

Lung fever (pneumonia) is rather sudden in its onset, 
attended with a stitch pain in the side, some pressure 
for breath, cough, and raising rusty colored matter, 
perhaps. Thus these added symptoms are needed to 
decide what particular fever is threatened. 

Children, even with slight ailments, are often feverish. 
A little indigestion, a slight cold, teething, irritation of 
the skin with a humor, constipation of the bowels, great 
fatigue, and many other causes easily bring on with 
them a rise of temperature and often a high fever. 

Mothers and nurses who have had but little experience 
with sick children are often alarmed at such symptoms, 
and fear that the child is about to have a real fever. 

Physicians sometimes gain great reputation in famil- 
ies from their success in "breaking up fevers," when 
they are only of this kind. Mother Nature is still more 
successful in such cases. 

When fever signs and symptoms begin, it is good 
practice to give the patient either tincture of aconite, 
sweet spirits nitre or Dover's powder and hot herb drinks, 
put him in a warm bed and try to produce sweating. The 
pores of the skin seem to be safety valves for eliminat- 
ing morbid materials. Undoubtedly many inflammatory 
attacks are cut short in this way. Modern treatment 
allows thirsty and fever-parched patients all the pure 
cold water to drink that they want, and it is thought that 
it is actually needed. In fevers the secretions are dried 
and water acts as a solvent and vehicle to remove dead 
and unhealthy materials from the system. Sponge baths 



A FEW INTRODUCTORY REMARKS. 21 

are of great benefit in cooling the skin and allaying the 
fever heat. 



Pain. — The following is from Robert Burns's Ad- 
dress to the Toothache : 

"My curse upon thy venom' d stang, 
That shoots my tortur'd gums alang; 
And thro' my lugs gies monie a twang, 

Wi' gnawing vengeance; 
Tearing my nerves wi' hitter pang, 

Like racking engines ! 

When fevers burn, or ague freezes, 
Eheumatics gnaw, or cholic squeezes; 
Our neighbour's sympathy may ease us, 

Wi' pitying moan; 
But thee — thou hell o' a' diseases, 

Aye mocks our groan ! 



O' a' the num'rous human dools, 

111 har'sts, daft bargains, cutty-stools, 

Or worthy friends rak'd i' the mools, 

Sad sight to see ! 
The tricks o' knaves, or fash o' fools, 
Thou bear'st the gree. " 

Since the first child screamed with colic-pain, or 
the first man groaned with a severe attack of facial 
neuralgia (tic douloureux), doctors and everybody else 
have been busy in trying to discover means of stopping 
pain or dis-ease It was discovered many years ago that 
opium and its various preparations were precious and re- 
liable agents in allaying insufferable pain, but it was re- 
served to the present century, as one of its marvelous 
achievements, to discover ether (1846) and chloroform 



22 HANDBOOK. 

(1847), wonderful triumphs over pain! The modern 
practice of injecting medicine under the skin is a long 
step in advance of former methods as the effect is quicker 
and less medicine is required to stop pain. 

Pain is the wail of an injured nerve, and it has a mer- 
ciful mission, because it calls attention sharply to the 
fact that some part of the body is becoming disordered 
and endangered and needs looking after. Strictly speak- 
ing all pain is neuralgic. The word neuralgia means 
pain in a nerve. Where there is no nerve there cannot 
be pain. Pain results from an over irritation of a nerve, 
such as inflammation and pressure upon it, or an irrita- 
tion of the nerve centers. It is seldom that pain alone 
is the immediate cause of death, but the loss of rest 
and food which it occasions is mischievous and exhausts 
the patients nervous force. There is a great difference 
in persons as regards their ability to bear pain. Pain 
may be dull or gnawing, and if so is generally constant ; 
it is the pain of chronic rheumatism, chronic inflamma- 
tion, and congestion. Acute or lancinating pain is a 
sharp and cutting pain, like that from a lancet, and is 
usually remittant ; such is the pain of colic, neuralgia, 
gastralgia (pain in the stomach) . Pain is also described, 
as darting, tearing, griping, stinging, burning, etc. We 
describe briefly the best common means of relieving pain. 
Moist heat has a remarkable soothing effect when the 
pain is not deep seated, and may be applied in the form 
of poultices or cloths wrung out of hot mustard water 
and frequently changed ; nothing is better for common 




Wm. T. G. Morton, m.d. 



The discoverer of Ether as an ansesthetic ; born in Berk- 
shire county, Massachusetts, in the year 1819. The first pub- 
lic trial of Ether for a severe surgical operation was in the 
Mass. Gen. Hospital, Boston, in 1846. In the presence of 
many distinguished physicians, Dr. Morton, then a dentist, 
appeared and etherized the patient, and Dr. J. C. Warren per- 
formed the operation, the patient being unconscious and suf- 
fering no pain. The renowned surgeon remarked, " Gentle- 
men, this is no humbug." Ether is now used the world over, 
yet its discoverer never received a fitting reward. The honor 
of the discovery has been unsuccessfully contested by Drs. 
Wells and Jackson. 



A FEW INTRODUCTORY REMARKS. 23 

use. Dry beat often answers a good purpose especially 
in sciatica. In cases of pleurisy, some forms of neural- 
gia, etc., a mustard poultice, or other forms of counter 
irritation, such as spirits turpentine, ammonia, are good 
as external applications. A mixture of equal parts of 
tincture aconite, essence of peppermint and chloroform 
is rather a dangerous remedy for everybody to handle, 
but is one of the best in neuralgic pain. In case of 
children, paregoric is of great use in relieving pain. Its 
use will be fully described in the following pages. Ger- 
man and English physicians use the tincture of henbane 
(liyoscyamus) in the painful and spasmodic attacks of 
children. It is, perhaps, safer than paregoric in young 
infants, and is less constipating. It is kept by all drug- 
gists. A little peppermint or anise water relieves the 
small pains of children. In the severe attacks of pain in 
adults some preparation of opium is by far the most re- 
liable internal medicine, but its indiscriminate use is some- 
what dangerous in infants and aged persons. In such 
cases paregoric or Hoffman's Anodyne may be given, but 
in cases of intense pain, when a physician cannot be ob- 
tained, a Dover's powder or laudanum in proper doses 
may be given with safety to an adult. Quinine is a 
remarkable remedy for some cases of neuralgia (espe- 
cially if it is periodical) , and it is free from the dangers 
of opium. 

Modes of Dying. — Dr. Oliver Wendell Holmes 
truthfully says : 

" Time shall cut the last of all my earthly stitches." 



24 HANDBOOK. 

But Massinger in another poetical statement says, 

" Death hath a thousand doors to let out life." 

This is hardly correct from a scientific standpoint, for 
there are only three ways in which we can die — three doors 
out of which life can walk. Death results either from : 

1. Failure at the brain. 

2. Failure at the lungs. 

3. Failure of the heart. 

First Mode. — When disease begins at the brain, or 
when it goes to it, the patient tends to die from what is 
called Coma, which means that he falls into a deep, un- 
conscious stupor, from which he cannot be aroused, and 
in which he may die. The brain, the great nerve-center 
of the body, becomes paralyzed, and life comes to a stand- 
still in consequence. Examples of this mode of death 
are apoplexy, poisoning from opium, morphine or other 
narcotics, injuries and diseases of the brain, and many 
other diseases. 

Second Mode. — Death from the second cause results 
from a failure of the respiration, or breathing. In this 
mode it may be truly said that " the patient died for the 
want of breath ; " it is called in technical language death 
by Apnoea or Asphyxia. Examples of sudden deatli of 
this kind are choking, strangulation by drowning, suf- 
focation from noxious gases, spasmodic croup, foreign 
bodies in the air passages, or any other cause which pre- 
vents air from entering the lungs. At first there is a 
violent effort to breathe, after which the face becomes 



A FEW INTRODUCTORY REMARKS. 2") 

swollen and purple, the eyes protrude, the body soon 
becomes relaxed, and last of all, the heart fails. In 
such cases artificial respiration is the only treatment that 
will save life, unless the en use can be immediately re- 
moved. This operation is fully described on page 113 
Gradual failure of the respiration is the cause of death 
in membraneous croup, congestion of the lungs, and in 
other diseases of the lungs. 

Third Mode. — Death from failure of the heart is the 
most common cause, and is called death by Asthenia, and 
results from a failure of the circulation of the blood. 
It may be sudden or gradual. Examples of sudden 
heart failure are found in diseases of the heart itself, in 
shock, fainting, profuse hemorrhage, lightning stroke, 
etc., etc. 

Gradual heart failure, or failure of the circulation is 
the most common and natural termination of life in all 
chronic and wasting diseases ; there is a gradual failure 
of strength, the pulse grows smaller, weaker, and more 
rapid, till the patient dies a quiet and painless death. 
It is in cases of failure of the circulation that stimulants 
of some kind are needed to keep the patient alive, to 
keep the heart from failing. 

Signs of Approaching Death. — As it is often 
the case that the inexperienced are alarmed and think a 
person is dying when he is not, it will not be out of 
place to give here a few of the most reliable signs and 
symptoms that denote that death is nigh. They are 



26 HANDBOOK. 

these : great feebleness and frequency of the pulse, or 
its absence in the wrist ; spasmodic or jerking Dreathing, 
except it is a case of hysteria. If profound Coma lasts 
more than twenty-four hours it will probably end in death. 
Loss of power over the bowels and bladder is a bad 
symptom, but not invariably followed by death. A col- 
lection of mucus or phlegm in the throat which the per- 
son makes no effort to raise, causes what is sometimes 
called " the death rattle." A tendency to slide down in 
the bed, a disposition to draw the arm towards the body 
when raised by any one. Difficulty in swallowing, cold- 
ness and lividity of the extremities, and a cold sweat upon 
the skin. What is called the Hippocratic countenance, 
so named because Hippocrates (4th century B. C), the 
Father of Medicine, first described it, is a sign of inevit- 
able death. The peculiar appearance of the face is this : 
great pallor, with a livid hue of the skin; a pinched look 
of the nostrils; the eyes and temples are sunken, and the 
lower jaw is dropped. The nose and ears become cold 
and moist. It may be said here that the talk about the 
"pangs of death" is not well founded on scientific 
grounds nor on common observation. The great ma- 
jority of persons die quietly and without suffering. The 
nerves of feeling become paralyzed, and the senses of 
sight and hearing are in abeyance. The angel of 
death, as if in pity, blindfolds us, and renders us deaf 
and speechless, before leading us through the dark val- 
ley. 



A FEW INTRODUCTORY REMARKS. 27 

ARE DISEASES CURED WITHOUT MEDICINE? 

From time to time in some quarters of the globe some 
medical reformer rises and proclaims that he has dis- 
covered a new art of curing all diseases without the use 
of medicines. Time and experience, which are the true 
tests of all such new things, have generally allowed such 
arts to die a natural death, and people have gone on tak- 
ing medicine for awhile longer. The history of medicine 
gives account of many such discoveries, both in ancient 
and modern times. The art of healing with charms and 
amulets, popular and extensively practiced in former 
times was the longest-lived of anything of the kind. 
Curiously enough, the relics of this practice are recog- 
nized to-day, but only believed by the ignorant, such as 
wearing red strings around the neck to prevent nose 
bleed, and curing warts by rubbing them with beans, 
then throwing the beans into the northeast corner of a 
well. 

A little less than 100 years ago, the treatment of dis- 
eases by the new art, Mesmerism, was popular in the 
great cities of Paris and London. Many physicians as 
well as others supported it. Mesmer, the inventor, was 
offered by the French government 20,000 livres at one 
time, as an annual pension to reveal the secrets of the 
method, which he refused. His practice soon fell into 
disrepute and Mesmer died in great obscurity in 1815. 
Of all successful modern medical juggleries, was that 
practiced in London by one Dr. James Graham about 



28 HANDBOOK. 

the year 1780. He established " The Temple of Health, " 
dedicated to Apollo, and its spacious and magnificent 
rooms became a place of fashionable resort. He claimed 
that the means of curing which he used were " the irre- 
sistible and salubrious influence of electricity or the ele- 
mentary fire, air, magnetism, and the Eternally Su- 
preme Jehovah Himself." This man called to his aid a 
certain kind of religious enthusiasm by inspiring his 
patients with it. He prepared in some way an " Elixir 
of Life" ; anyone who took it might live as long as lie 
wished ; price £100 to be paid in advance. Over the 
doors of the principal rooms of his temple, and in the 
arches of the halls, were displayed the walking-sticks, 
crutches, ear-trumpets, eye-glasses, etc., left by his 
patients who had no further use for them. But the glory 
of Graham's art of healing died before its inventor. 

Such is a brief account of a few of the most remark- 
able arts of curing diseases without medicine which have 
been practiced in former times. 

The latest theory and practice in tlie art of healing is 
the " Christian Science Cure," which is attracting con- 
siderable attention in New England. Its pathology or 
doctrine of disease is entirely different from all others 
which have been advanced. It is founded upon meta- 
physics or mental philosophy, and not upon physics ; it 
ignores in theory the existerce of the material body, 
claiming that everything is mind, or spirit ; that the 
body is only an image or ghost projected from the mind, 
and that it is consequently thinner and more unsub- 



A FEW INTRODUCTORY REMARKS. 29 

stantial than the Aurora Borealis which flits across the 
northern skies. The mind, being real, may be sick, but 
how can an image or a ghost be sick — this is the theory. 
There have been, without doubt, many cures performed 
by this new method, and there will be many more. 
There can be no doubt in the mind of any observant 
physician, that imagination or faith in the means used 
is a very important factor in curing a certain class of 
diseases. The old story of curing patients with " brown- 
bread pills," the patient supposing them to be good 
medicine, is probably a true one, physicians, at least, 
believe it. A circumstance which recently happened 
strikingly illustrates the depressing influence the mind 
has over the body. A butcher in attempting to hang 
a piece of meat on a hook, slipped, and drew the hook 
into the arm and was suspended. He became pale and 
senseless, and was supposed to be dying ; surgeons were 
called in great haste. His clothing was carefully re- 
moved to examine the arm, when it was found that the 
hook only grazed the skin, and had not torn the arm as 
the man imagined. 

On the other hand, there is every reason to believe 
that there is strength, health-giving, and wondrous cura- 
tive power in joy, expectation, and faith, and not only 
peace, but health in believing. There is another factor 
which, although invisible and intangible, is the most im- 
portant agent in curing diseases, and one which underlies 
and makes apparently successful so many opposing 
methods of healing. This ao-ent is Vis Medicatrix 



30 HANDBOOK, 

Naturm, the healing power of nature. This Vis is a 
powerful aid to the doctor whatever his name or nature. 
It revives the patient, spreads on the healing salve, and 
magnanimously allows him to carry off the credit of 
the cure. In estimating the apparent success of Faith 
Cure, Christian Science Cure, the cure by charms and 
incantations, the recuperative power of nature must 
always be credited with a certain amount of curative 
energy. Another generous ally in all arts of healing 
and the physician's invisible copartner is Dr. Quan- 
tum Sufficit Temporis (sufficient time). When other 
doctors fail, this one often cures the patient. Good 
nursing is another factor in the art of healing which 
deserves a conspicuous place among curative methods, 
and in many instances it is of more importance than 
medicine itself. Unless medicine is wisely selected and 
plainly needed the chances are better without medicine, 
and with good nursing. The error of relying entirely 
upon medicine, even if ignorantly prescribed, is com- 
mon. Patent medicine is often relied upon and con- 
tinuously taken for a long time in expectation of a cure, 
to the neglect of other important means. In many in- 
stances, diet, rest, a change of occupation or out-door 
exercise is needed more than medicine ; yet, even under 
unfavorable conditions, health at last returns in fortu- 
nate cases. Every wise physician recognizes the 
fact that in the majority of diseased conditions there 
is a strong tendency to recovery ; that unless some ob- 
stacle is in the way which nature cannot remove, the 



A FEW INTRODUCTORY REMARKS. 31 

patient marches on to convalescence in numerous cases. 
There are other important ways of curing diseases, such 
as those by Massage, Electricity, The Sweedish Move- 
ment Cure, Sea Voyages, Mountain Climbing, etc., etc. 
Dr. Weir Mitchell has made himself famous by his 
methods of curing nervous diseases without the use of 
medicine. The tendency of later years, among sensible 
physicians is, not to follow the old cast-iron methods, 
but to divide patients into classes, and say this one needs 
medicine, this ODe does not. Yet experience and com- 
mon sense assign to medicine a large place among the 
varied means of assisting nature to remove disease and 
to cure pain. 

Patent Medicines. — " It is a balsam," answered 
Don Quixote, . . . " and all thou wilt have to do when 
thou seest me in some battle cleft asunder (ns it fre- 
quently happens) , is to take up fair and softly that part 
of my body which shall fall to the ground and with the 
greatest nicety, before the blood is congealed, place it 
upon the other half that shall remain in the saddle, tak- 
ing especial care to make them tally exactly. Thou shalt 
then give me two draughts only of the balsam aforesaid, 
and instantly thou wilt see me become sounder than an 
apple. " 

The quantity of patent medicine consumed yearly in 
this country is something enormous. If the liquid could 
be poured into one channel it would make a respectable 
Niagara river, at least, in size. It is swallowed mostly 
by persons who are not severely sick, but by those who 
do not feel just right and think they need medicine, and 
trv a bottle of it, thinking it may " hit the right spot." 



32 HANDBOOK. 

If they get well in time, they credit the medicine with a 
cure. The fact generally is, that recovery takes place 
not on account of the nostrum swallowed, but in spite of 
it. One bottle is skilfully advertised to cure many 
different diseases. This would seem something like the 
man who, desiring to bring down some game, loaded up 
his shot gun, went into the woods where game was sup- 
posed to be, and blazed away at random, thinking he 
might hit something ; if anything happened to be in the 
way, he probably would. According to the law of 
chances the result would be about the same in taking a 
bottle of patent medicine, loaded with a " scattering 
charge. " 

Sarsaparilla mixtures are popular patent medicines 
just now ; what are the facts about their probable medic- 
inal effects? Sarsaparilla itself, as a medicine, is 
uncertain and doubtful in its effect, and by many 
intelligent ph} T sicians, is considered inert. The other 
principal ingredient of these mixtures is doubtless the 
Iodide of Potassium. This is an excellent remedy in a 
few disorders in their particular stages and forms, such 
as asthma, chronic bronchitis, secondary sj^philis, etc. 
With the exception of this very limited number of dis- 
eases, this medicine does more hurt than good, as in 
ordinary cases of weakness and debility, indigestion, etc. 
Instead of " purifying" the blood, it introduces into it a 
foreign substance which makes it impure, and nature 
struggles to eliminate or get rid of it. Such is the teach- 
ing of the most scientific physicians of to-day. For the 



A FEW INTRODUCTORY REMARKS. 33 

weak, anaemic, and poorly-fed person, nice, tender beef 
steak would be a hundred times better medicine. 

The latest taking, preposterous " fad " is the " Microbe 
Killer. " A shrewd truck-farmer, seeing his opportunity 
in the common talk among scientific men about the Germ 
Theory, adopted the dictum, " all diseases are caused by 
Microbes " (germs) , puts up his " Killer" in jugs, at $3 a 
jug, loaded with a sure cure for nearly all diseases. This 
mixture, it is said, is having a big sale all over the 
country. One writer says, " the inventor's factories will 
increase in numbers and his pocket-book in size, till his 
4 gulls ' are educated out of their folly. " 

What are the facts about the Germ Theory of diseases ? 
It is yet uncertain and obscure as to just what diseases 
are caused by Microbes. Scientific men, with eye-sight 
magnified a thousand times by means of the microscope, 
are peering into diseased tissues to find, if possible, 
these minute creatures ; they are, to be sure, sometimes 
found, but whether the cause of disease, or the result of 
it, is not yet fully decided, and when it is, if ever, the 
discovery of a universal Germ or Microbe Killer will be 
an achievement of such brilliancy and magnitude that 
it will surpass that of Columbus in the discovery of the 
New World. Has this enterprising farmer discovered it ? 

We wish to keep truth and fairness on our side, and 
therefore we say that we do not condemn every patent 
and proprietary medicine as utterly worthless. There are 
probably some kinds, designed for some particular dis- 
order, that may do good. It would be the best plan, if 



3<± HANDBOOK. 

a person is inclined to cure himself with these nostrums, 
to consult, in the first place, some skilful physician, and 
find out just what the disease is, for which he proposes 
to take medicine. It is undoubtedly true that the more 
one knows about the nature of disease and the means by 
which it is cured, if cured at all, and the more he learns 
about the composition of patent medicine, the less and 
less confidence he will have in its efficacy. 

In the line of quack medicines we come to Quack 
Doctors. What is a quack doctor? In a standard medi- 
cal dictionary which we have before us, " Quackery" is 
defined "mean or bad acts in physic," comprehending 
not only the absurd impostures of ignorant pretenders, 
but also unbecoming acts of professional men themselves. 
Webster defines a quack as a boastful pretender to med- 
ical skill. While it is true that there is more or less 
quackery among the "regulars," the term quack is 
mostly applied to ignorant pretenders to medical skill 
which they do not possess. 

A little experiment was tried in the city of Boston in 
1888, to test the skill and honesty of the quack doctors 
of modern Athens. Two reporters started out. Num- 
ber One had a simple cold sore on his lip, which was 
touched a few times with nitric acid to keep it from 
healing too quickly. Number Two had nothing but a 
/ a d spot on the lip, made by irritating it with nitric acid. 
Eighteen quacks were "consulted." In every case the 
sores were pronounced either cancers, cancerous humors, 
or sores that would lead to cancers — dangerous, and need- 



A FEW INTRODUCTORY REMARKS. 



35 



ing immediate treatment, which would cost from £15 to 
$25 a week, and might require several weeks to cure. 




Quack Doctor finds a Cancer where there is None. 

These " cancers " healed in two days with- 
out treatment. 
These are specimens of a very large class of " doctors " 
found in every large city. Their skill consists entirely 



36 HANDBOOK. 

in their ability to deceive, humbug and cheat the patient 
out of money, and many of them drive a very prosperous 
business at it. Most of the travelling doctors belong to 
the same class. They stop at hotels for a few days, and 
advertise themselves as great specialists, and promise a 
sure cure in all cases. People are wise who avoid them. 

A Medicine Case. — Every family, particularly 
every one living at a long distance from a drug shop, or 
from a doctor, should keep in the house a little box of 
medicines. The cost would be small, but the presence 
of such a supply might be the source of great comfort in 
such exigencies as are liable to arise. 

A small tin or wooden box which can be locked, in 
which to keep the medicines, should be obtained, for in 
this way the vials are all in one place, and can be easily 
found when wanted. The supply should be bought of a 
reliable druggist, who will, if requested, plainly label 
each vial. For reasons, it is not best that the number of 
such medicines should be large. The following is a list 
of medicines which will be found most generally useful : 

Syrup of Ipecac, 2 oz. 

Paregoric, 2 " 

Bromide of Potassium, . ... . 2 ■ ." 

Laudanum (Tr. Opium), . . . 2 " 

Sweet Spirits of Nitre, . . . 2 " 

Sweet Tincture of Rhubarb, . . . 2 " 

Aromatic Spirits of Ammonia, . . 2 " 

Vaseline or Cosmoline, . . . . 2 " 

Carbolic Acid (Crystals,) . . . 2 " 

Sulphate of Zinc, 2 " 



A FEW INTRODUCTORY REMARKS. 37 

The box should also contain one roll of Surgeons' 
Rubber Adhesive Plaster, one box of ground mustard. 

Syrup of Ipecac. — For an emetic dose, a table- 
spoonful to an adult, in a cup of warm water, repeated 
every 15 minutes, till vomiting takes place. For a child, 
one teaspoonful, repeated if needed. This is a safe, but 
not very quick emetic. When a person has eaten some- 
thing which gives great distress, spontaneous vomiting 
often takes place ; when it does not, it should be 
encouraged by a dose of Ipecac, or something of the 
kind, assisted by copious drinks of tepid water. Con- 
vulsions in children are most frequently occasioned by 
undigested food. Syrup of Ipecac, enough to produce 
vomiting, generally puts an end to the trouble. 

Spasmodic croup generally comes on during the first 
part of the night, and it is attended with some danger, 
and needs prompt treatment. A few doses of Ipecac, if 
in the house, is one of the best remedies known, gener- 
ally effecting a cure. If something poisonous has been 
swallowed, large doses of Ipecac, given in considerable 
.warm water, will empty the stomach, and may save life. 
The sulphate of zinc is quicker in its action, and on this 
account, better in cases of poisoning. In the summer 
complaint and dysentery of teething children, small 
doses of Ipecac, often repeated, is excellent treatment. 
Emetic doses of Ipecac sometimes relieves sick-headache 
and asthma. To " break up a cold " take teaspoonful 
doses of Syrup of Ipecac every hour, beginning as soon as 



38 HANDBOOK. 

the cold is first felt, and for an adult 25 drops of laudanum 
at bed time ; retire early, and encourage sweating by large 
quantities of warm drinks. 

Paregoric given in a little sweetened water is not 
disagreeable to the taste, and is a popular remedy for 
children ; much safer and better than the soothing syrups 
which contain large quantities of opium. 

OBDISTARY DOSE: 

Three months old, .... 5 drops 

One year old, 15 drops 

Five years old, 20 drops 

Ten years old, 30 drops 

In colic-pain, pain and distress in the stomach, 
crying and restlessness from slight ailments, painful 
teething, Paregoric in proper doses, and repeated if 
needed, relieves the pain and quiets the excitement and 
irritability of the nervous system. It is probably true 
that it not only relieves pain, but that in many cases, 
through its power of allaying vascular and nervous irri- 
tability, it prevents or cures inflammatory diseases. Dry 
and irritable cough is benefited by a few small doses of 
Paregoric. 

Generally speaking, it is a cure for the common 
diarrhoea of chilclren, if first some mild physic, 
like castor oil or rhubarb, is given to clear the in- 
testines of irritating substances. This medicine in one- 
half tablespoonful doses will often cure the milder forms 
of colic, as well as some forms of diarrhoea in adults. 



A FEW INTRODUCTORY REMARKS. 39 

Bromide of Potassium. — Dose 15 to 30 grains 
(1-4 to 1-3 teaspoonful) dissolved in much water. In 
wakefulness from over-excitement, mental over-work, 
anxiety and worry, producing, as they do, slight conges- 
tion of the brain, no medicine is better than this ; it 
generally procures quiet and refreshing sleep ; besides, 
it is a safe medicine in unprofessional hands. 

In what is called congestive sick-headache, when there 
is flushed face, throbbing temples, intolerence of light 
and sound, the bromides have a wonderfully good effect. 

In nervous attacks, " the fidgets and hysterics, " and 
in forms of great nervous excitement, the same remedy 
is called for. As a preventive of convulsions in children, 
it is often prescribed by physicians. When taken in 
large quantities and continued, no medicine so well con- 
trols epileptic fits. After blows upon the head, wounds 
of the scalp, and in other injuries, when the head is hot, 
and there is throbbing pain, no treatment is so good as 
cold water upon the head, and the Bromide of Potassium 
internally. It is said on good authority that spasmodic 
asthma is sometimes greatly relieved by this medicine. 
Whooping-cough is a spasmodic disease, and many phy- 
sicians give Bromide of Potassium in sufficient amounts 
to control the severe spasms. The remedy is perfectly 
safe. The bromides are regarded as nervous tonics, or 
strengthened in nervous conditions. 

Laudanum — Tincture of Opium. — Opium is 
one of the most wonderful drugs ever discovered, first of 



40 



HANDBOOK. 



all in its power to relieve pain. While it is powerful for 
good, it is also powerful for harm. Infants and aged 
persons are susceptible to its ill effects, and its common 
use in unskilful hands is, by all means, to be discouraged. 
The danger is that the person might fall into a fatal 
stupor, when it is used in too large doses ; yet, when 
there is reason to believe that it will be cautiously and 
intelligently used, it will make a valuable addition to 
the medicine box. 



Six months old, . 


2 drops 


One year old, 


. • 4 " 


Four years old, 


6 " 


Ten years old, 


. 15 " 


Twenty years old, 


. 20 " 


Adults, 


. 30 " 



A bottle of Laudanum should be plainly marked 
Poison, and never given internally except in the exigency 
of great pain, and then its use should be stopped imme- 
diately when the pain lessens. It may be said in a 
general way, that for all painful attacks or injuries, in 
robust and middle-aged persons, in such cases as colic, 
cholera-morbus, neuralgia, inflammation and stoppage of 
the bowels, dysentery, severe pain in the stomach, and 
soon, while the pain continues intense, a dose maybe 
given everyone half hour till it begins to yield. Lauda- 
num in full doses is not always well borne on the stomach, 
often producing nausea and vomiting. In such cases, a 
few drops, two or three, maybe given every few minutes 
till the required amount is taken. 



A FEW INTRODUCTORY REMARKS. 41 

In painful attacks, doctors often apply Laudanum 
externally ; it is often beneficial and not dangerous ; for 
any of the purposes for which the tincture of arnica is 
so often used externally, Laudanum, either clear or 
diluted with water, is much more effective. \Vhen in 
painful affections poultices are applied, Laudanum ma}' be 
first poured upon them. Dover's powder, renowned 
almost the world over among physicians, is made princi- 
pally from Opium and ipecac. A little of the syrnp of 
ipecac and Laudanum combined has nearly the same good 
effect. It is of great value in the onset of nearly all 
feverish and painful attacks, such as severe colds, bron- 
chitis, etc. 

Sweet Spirits of Nitre. — Dose twenty drops to a 
teaspoonful. This is a well known medicine to most fami- 
lies. It is a mild and harmless remedy, yet has a good 
effect in mild cases. It may be given to children when 
they are feverish and restless. It has a cooling effect 
upon the skin, and when the patient is warmly covered in 
bed, after a few doses are given, it tends to moisten the 
skin with a gentle perspiration, which, in all feverish 
conditions, is beneficial. In some kinds of kidney and 
urinary affections, it may be taken with advantage ; the 
effect will be better when, at the same time, plentiful 
drinks of an infusion of cleavers, buchu, bear-berry 
leaves or some other herb drinks are taken. 



-±2 HANDBOOK. 

Aromatic Tincture of Rhubarb. — Dose for a 

child two years old one teaspoonful. Besides being 
agreeable to the taste, and one of the best laxatives for 
children, (when a little soda is added.) it is a good cor- 
rective for the stomach and bowels. In the summer 
bowel complaints of children, when there is painful and 
frequent green stools, a laxative dose night and morning 
is one of the best remedies that can be prescribed ; a few 
drops of paregoric may be added to prevent griping. 

In cases of nausea, vomiting and colic pain, with either 
diarrhoea or constipation, a few doses of the Tincture of 
Rhubarb, with a little soda, will generally cure the 
trouble. Castor oil is often given to children. It acts 
quicker than Rhubarb, but it does not stimulate and 
remove unhealthy secretions from the stomach and bowels 
like the latter. 

For these various disorders of the digestive organs so 
common with children, where gentle physic works such a 
wonderful change for the better. Rhubarb is the desirable 
kind. In older persons with disorders of the same 
nature as described above, the same treatment is bene- 
ficial. The dose of this form of Rhubarb for an adult is 
from one to two tablespooufuls. \Yith some persons it 
produces so much griping pain that something else is 
better. The simple Tincture has the same use but is not 
so agreeable to the taste of children. 

Aromatic Spirits of Ammonia, in one half tea- 
spoonful doses in much water, is a quick stimulant to the 



A FEW INTRODUCTORY REMARKS. 43 

action of the heart. The dose may be repeated every 
few minutes if required. In cases of alarming depres- 
sion, shock, failing circulation, fainting, nervous failure, 
etc., it is a reliable stimulant. In any case seeming to 
need alcoholic stimulants, if they are not at hand, Spirits 
of Ammonia may be substituted. Some cases of acidity 
of the stomach, eructations of gas and distention of the 
bowels with gas are relieved as by magic with a few 
doses of the Spirits of Ammonia. In some cases of so- 
called bilious conditions, with constipation from scanty 
secretions of the intestinal juices, coated tongue and 
scanty and high colored urine, this medicine is called for. 

Children and infants are often fretful on account of 
indigestion, and a soul- or acid condition of the stomach. 
Small doses of Ammonia will often correct this condition. 

Nervous headache from acidity of the stomach is some- 
times cured quickly with a few doses of the Spirits of 
Ammonia. It is one of the very best remedies to apply 
for mosquito and other insect bites, and many surgeons 
recommend it for the bites of venomous serpents and 
rabid animals. 

A person may sometimes be aroused from the stupor 
of narcotic poisoning by holding to the nose the Spirits, 
perhaps better by the use of Aqua Ammonia. 

Gosmoline or Vaseline. — These substances are of 
the same nature and uses ; they always remain of the 
same consistency, about that of jelly, and do not spoil 
or become rancid. They are now extensively used by 



14 HANDBOOK. 

druggists in making all kinds of ointments. There is 
nothing better as a dressing for burns and wounds, 
especially when healing is taking place, when some mild 
and oily substance is needed to protect the surface 
from the air and from friction ; for this purpose 
the carbolized preparations are the best. They are 
spread upon soft materials, and applied directly to the 
wound or burn. Slight wounds do well dressed in this 
way as soon as bleeding has stopped. 

There is probably no one thing so certain to cure, or 
to improve the condition of old sores and foul ulcers, as 
the Iodoform Ointment which may be made from 10 
parts Iodoform and 90 parts Cosmoline. For all pur- 
poses calling for a simple ointment, Cosmoline may be 
used. 

Carbolic Acid is a good medicine to have in the 
house. It should be labelled Poison, as a precaution. 
It is a germ or microbe killer, and as such, prevents 
putrefaction in wounds ; on this account, all extensive 
wounds should be drenched in a weak solution of it be- 
fore dressing them ; if used in this way, it is called an 
antiseptic. In washing and cleansing all wounds, foul 
sores and ulcers, a little of the solution should be added 
to the water. 

A solution of Carbolic Acid is one of the best disin- 
fectants in cases of contagious diseases, and will here- 
after be noticed in this connection. For small burns 
and scalds, which housewives are constantly getting, a, 



A FEW INTRODUCTORY REMARKS. 45 

mixture of equal parts of Carbolic Acid and cosmoline 
or glycerine smeared on the part a few times, is one of 
the very best cures. There is nothing known to the 
writer so prompt and certain to relieve intense itching of 
the skin as a mixture of one part of the .Acid, and four 
parts of cosmoline or vaseline. 

For further important uses of Carbolic Acid, see arti- 
cles Mosquito Bites, Wounds, and Contagious Diseases. 
The Acid can be bought of druggists either in the form 
of the crystals, or the solution. To make the solution, 
having the Acid, add four teaspoonfuls to one pint of 
hot water. 

Sulphate of Zinc (White Vitriol) should be kept 
principally as an emetic in cases of poisoning ; it is the 
quickest and best in such emergencies, and is called for 
in all cases excepting when acrid or burning poisons have 
been swallowed, such as strong acids and alkalies. 
Dose of the Zinc, one half teaspoonful in a cup of warm 
water, repeated in ten minutes if vomiting is not pro- 
voked. Large drinks of tepid water assist its action. 
In all cases when a quick emetic is needed this may be 
given — in spasmodic croup, the convulsions of children 
from undigested food, etc. 

Ground Mustard. — If in cases of poisoning an 
emetic is urgently needed, and nothing better is at hand, 
add two teaspoonfuls of Ground Mustard to a cup of 



4b HANDBOOK. 

warm water, and give ; repeat the dose every ten minutes 
till vomiting takes plnce. 

The mustard plaster is known to most persons. The 
plaster is called by doctors a kt counter irritant. " When 
there is pain or inflammation of any internal organ or 
part, neuralgia, colic, inflammation of the bowels, dis- 
tress in the stomach, or obstinate vomiting, pleurisy or 
pain in the lungs, etc., a mustard plaster applied to the 
skin over the part may relieve the pain and help to cure 
the disorder. Ground Mustard is often added to hot 
water, out of which cloths are wrung ; it seems in cases 
of pain to increase the good effect. 

To make a mustard plaster, mix the meal and equal 
parts of flour with warm water to the thickness of cream. 
Hot water drives off the volatile oil, and lessens its 
strength. Clear Mustard is too strong to give the best 
effects ; it cannot be kept on the skin long enough, and 
is apt to raise a blister, which is very painful and hard 
to heal. Some thin material, muslin or an old handker- 
chief, should be spread over the plaster before applying 
it. Children do not bear a mustard plaster very well. 
When Mustard is not at hand, cayenne pepper may be 
substituted, but mixed with three or four parts of flour. 
Spirits of turpentine poured upon flannels and applied, 
may also be substituted, and has nearly the same effect 
as Mustard. 



A FEW INTRODUCTORY REMARKS. 47 

WHAT MEDICINES ARE IN THE HOUSE. 

Good housewife provides ere a sickness do come, 
Of sundry good things in her house to have some. 
Good aqua composita, and vinegar tart, 
Rose water and treacle, to comfort thine heart ; 
Cold herbs in her garden, for agues that burn. 
That over strong heat to good temper may turn. 
Conserves of barberry, quinces and such, 
With syrups, that easeth the sickly so much. 
Get water of f umatory, liver to cool, 
And others the like, else lie like a fool. 

Thomas Tusser (London, 1^57-) 

In a sudden call for medicine, common household 
remedies sometimes constitute the only Materia Medica 
at hand, but, fortunately, many of these remedies found 
in the most humble dwelling house are of great impor- 
tance, and may be just what are needed. It is well to 
know what they are, and what useful purposes they 
may serve. 

Hot and Cold Water. At the head of the list of 
household remedies, water deserves a conspicuous place. 
No other common remedy is of such important and gen- 
eral use. It is said now-a-days that doctors use hot or 
cold water for everything. For external application, 
cloths wrung out of hot water, hot poultices or bags of 
herbs dipped in hot water, have about the same effect, 
which is owing to the moist heat which they contain ; 
they soothe the tine, sensitive nerves of a painful part, 
and prevent congestion and inflammation to a consider- 
able extent. In pain, redness and swelling of any ex- 
ternal part, the application of hot water or poultices is 
usually called for. Of late it is thought by many phy- 
sicians that ice-cold water is more effective in certain 
cases of inflammation. For painful bruises, lacerated or 
torn wounds, punctured and gun-shot wounds, nothing 
is better at first than the hot water dressing ; it moderates 
inflammation, pain and swelling. Severe and painful 
sprains of any joint are best treated, at first, when they 



48 



HANDBOOK. 



are wrapped in flannels dipped in iced water, or, if 
much more agreeable to the feelings of the patient, the 
hot water may be substituted. Keep the part at perfect 
rest. In cases of broken bones or dislocations, when it 
requires a long time to get a surgeon to " set the bone," 
the part should be placed in a position the least painful, 
and wrapped in flannels wrung out of hot water, or in a 
bag of wormwood dipped in hot water. In injuries of 
the head, when there is heat and throbbing pain, and a 
full, strong pulse, ice-cold water to the head is by far 
the best treatment. In acute inflammation of the eyes, 
and in injuries of the eye, cloths dipped in cold water 
should be applied. For that dangerous accident, sun- 
stroke (heatstroke), when the head and the skin are 
burning hot, and the pulse strong and full, no remedy is 
worthy of mention compared with ice-cold water to the 
head and skin, or the cold douche. 

In nearly all painful and inflammatory diseases of the 
bowels, the use of hot water or hot poultices is of un- 
questionable benefit. A very important, if not an essen- 
tial part of the treatment of fevers, when the skin is hot 
and dry, and the pulse full and strong, is the cold sponge 
bath ; it moderates the fever heat to a remarkable de- 
gree. The hip or sitz-bath is exceedingly beneficial in 
painful and inflammatory diseases of the urinary and 
other organs situated in the lower part of the body. 
Steam is a convenient and effective remedy for tooth- 
ache and earache; see pages 193 and 196. In cases of 
severe constipation, or threatened stoppage, it should be 
remembered that copious and repeated injections of 
warm, soapy water, (with a little glycerine added if at 
hand), is a measure of almost the first importance as a 
safe and quick cure — better than the slow work of pills, 
especially for children. This is but a brief beginning of 
the long list of injuries, painful attacks, and other ail- 
ments, in the treatment of which hot or cold water is a 
convenient and effective remedy. 

Poultices. From remote times down to the present, 
hot ])oultices of various kinds have been used as cura- 



A FEW INTRODUCTORY REMARKS. 49 

tive agents. As stated above, they have about the same 
effect as cloths wrung out of hot water, dependent upon 
the moist heat which trhey convey. Whenever hot 
cloths have been advised, hot poultices may be substi- 
tuted, and are preferred when the supply of moist heat 
needs to be continuous for many hours ; but in cases of 
very severe pain, as in colic, neuralgia, etc., thick, heavy 
flannels, wrung out of water as hot as can be borne, and 
renewed every few minutes, are decidedly better in con- 
trolling the pain, because they furnish heat of greater 
intensity. In the cases of external inflammation, hot 
poultices have the preference, as for instance, in ab- 
scesses, boils, carbuncles, etc. In the latter class of 
cases, laudanum poured upon the poultice increases the 
anodyne, or pain killing effect. When hot cloths are 
used, as in cases of colic, cholera morbus, neuralgia, 
pleurisy, etc., if a little ground mustard is added to the 
hot water, the anodyne effect is greater. The instances 
in which hot poultices a~e called for are too numerous 
to be described here. Flaxseed (linseed) meal stirred 
up in hot water makes an excellent poultice ; so does 
ground slippery elm. Tf nothing ehe is at hand, a good 
poultice may be made of bread or crackers mixed up 
with hot milk till a mass of the proper consistency is 
formed. To prevent a poultice from sticking to the 
skin, a piece of oiled muslin may be first spread over it. 
Ice. As indicated above, ice has its use when added 
to water to increase the degree of coldness. Pounded 
ice to swallow is beneficial, and very grateful to the 
patient in tonsillitis, diphtheria, inflammations of the 
throat and stomach ; it will sometimes stop troublesome 
vomiting. In that case of danger, strangulated hernia, 
Avhen the tumor is tense and painful, and cannot be re- 
turned at once, the application of a bag of pounded ice 
or of iced water, till the hernia can be reduced, is the 
best treatment that any non -professional person can 
undertake. An abscess may be lanced without pain by 
taking a small lamp chimney, inverting the small end 
uj:>on the skin, then pouring into it a freezing mixture 



50 HANDBOOK. 

composed of a little pounded ice mixed with an equal 
quantity of salt; in a few minutes the skin becomes 
white and nearly frozen, when the cutting may be done. 
In hemorrhage from the lungs, ice-cold water, applied to 
the front and upper part of the chest and to the back, 
is the most effective treatment. 

Dry Heat, when applied to the skin, is a quick and 
powerful stimulant to the action of the heart. Death 
sometimes takes place from simple heart failure in cases 
of fevers, heart disease, poisoning, drowning, shock, etc., 
when it might possibly be prevented by keeping the 
flagging circulation agoing awhile by artificial heat. In 
all kinds of attacks when the extremities become cold, 
the circulation should be stimulated by dry heat applied 
to the skin. Neuralgia of the larger nerves, such as the 
sciatic, is relieved by the constant application of heat. 
Bags of hot sand or salt, or hot bricks, may be used, or 
any other convenient means of supplying constant heat 
to the part. Subacute rheumatism, neuralgia, toothache, 
earache, and many kinds of pain, are greatly relieved by 
dry heat. The good effect of hot steaming cloths and 
poultices is largely owing to the heat they convey to the 
painful part. An important means of restoring persons 
drowned, is the application of dry heat to the body ; it 
stimulates the circulation, and often saves life, when 
assisted by artificial respiration. Persons of feeble 
health are often prevented from taking cold, after ex- 
posure to cold and dampness, by taking hot drinks, and 
heating their feet and legs for some time, before retiring. 

Emetics, In cases of Poisoning, Croup, and in cer- 
tain cases of Bronchitis in children, in over-eating, or 
eating food which disagrees with the person, producing 
great distress, or cramp-like pain in the stomach, an 
emetic may be urgently needed, so much so that it 
might possibly save life. What things are in the house 
that will act as emetics? The simplest is luke-warm 
water. It needs to be taken in large quantities — let a 
person drink all he can hold, and, in an emergency, 
thrust his finger down his throat to provoke its quick 



A FEW INTRODUCTORY REMARKS. 51 

action. A table spoonful of ground mustard added to a 
pint of warm water makes an excellent emetic. A tea- 
spoonful of powdered alum in warm water acts as an 
emetic. Two teaspoonfuls of fine salt taken in a pint 
of tepid water generally produces vomiting. In poison- 
ing, to induce immediate vomiting is the plain and 
essential thing to be done, excepting in poisoning by 
caustic acids and alkalies, (in which cases an emetic 
would be harmful), and excepting cases in which spon- 
taneous and free vomiting takes place. It is unques- 
tionably true, that in children, a threatened attack of 
bronchitis, cold in the head, tonsillitis, croup, etc., can 
be, in many instances, cut short or altogether prevented, 
by giving at the very first one or more emetics. It acts 
upon the skin, promotes perspiration and other secre- 
tions, and has a decided and curative effect. The syrup 
of Ipecac is the best for children. Hive syrup, or the 
syrup of Ipecac should always be kept in the house 
where there are children for the prompt treatment of 
croup and bronchitis. 

Spirits of Turpentine. There is the highest author- 
ity for saying that this medicine is one of the best reme- 
dies for the treatment of diphtheria, and for the preven- 
tion of its spreading by contagion to other persons in 
the house. It is certainly known to be a powerful 
germ-destroyer, and as diphtheria is a germ-disease 
there is reason for its use. Full directions about the 
methods of using it will be found under the subject 
Diphtheria in this book. Turpentine has long been 
used for checking hemorrhage from internal organs, 
such as the lungs, stomach, intestines, nose, etc. It may 
be given in one-half teaspoonful doses stirred up with 
the white of an egg y or in milk ; and repeated every 
one-half hour if required. Turpentine stupes are much 
used as an external application in treating inflamma- 
tions of internal organs, such as inflammation of the 
bowels, pleurisy, gastritis, etc. Pieces of flannel large 
enough to cover the inflamed or painful part are wrung 
out of hot water, then a few drops of turpentine (8 or 



52 HANDBOOK. 

10) are sprinkled on and applied, taking care that no 
blistering is produced. The same application is used 
for neuralgia, painful rheumatic joints, muscular rheu- 
matism, lumbago, etc. 

In nearly all cases where a mustard draught is rec- 
ommended, turpentine stupes may be substituted. Burns 
have been successfully treated by covering the burnt 
skin thickly with a mixture of vaseline, or mutton tallow, 
and a little turpentine. In many cases of flatulent dys- 
pepsia, and intestinal catarrh, a few drops of turpentine 
(5 or 6) taken on a little sugar, acts wonderfully well. 
We often hear it said that turpentine is "weakening " ; 
the contrary is true ; it is a certain stimulant to a weak 
heart, and failing circulation. 

Ground Mustard. For the medical uses of this com- 
mon household condiment, see page 45. 

Cayenne Pepper (Capsicum) and Jamaica Ginger. 
Seventy-live years ago, botanic doctors relied upon 
cayenne pepper as one of their principal medicines. 
When for any purpose a stimulant is needed one-half 
teaspoonful of Cayenne, mixed with warm, sugared 
water and milk, may be taken. For the sluggish and 
painful digestion of atonic dyspepsia, for mild attacks of 
colic, and cramp in the stomach, it acts well. There is 
good reason for saying that Cayenne in sufficient quan- 
tity will prevent an attack of delirium tremens. For 
the indigestion of hard drinkers, Capsicum is very bene- 
ficial. It will often break up a distressing attack of 
hiccough. It may be substituted for ground mustard 
in its use as a counter irritant. 

Jamaica Ginger has nearly the same effect as Capsi- 
cum, but is less powerful. Ginger is certainly a most 
excellent remedy in cases of slight indigestion and dis- 
tress in the stomach after eating. It forms the princi- 
pal active ingredient of a popular medicine sold under 
the name, Bismuth Mixture. When ginger is needed 
as a stomach corrective the effect is better if a little 
soda is combined. 

Coffee is stimulant to the nervous system and to the 



A FEW INTRODUCTORY REMARKS. 53 

action of the heart. As a medicine it is very often 
given as an antidote for morphine, laudanum and opium 
poisoning; as such it is a convenient remedy, nearly 
always at hand. In cases of an over dose of an opiate 
of any kind, strong coffee without milk or sugar should 
always be given after an emetic has emptied the stom- 
ach. In cases of great weakness and a tendency to 
failure of the heart's action, it may be given as a stimu- 
lant, when nothing better is at hand. Coffee relieves 
some kinds of headache, especially the headache follow- 
ing drunkenness. Tea has about the same effect as a 
medicine as coffee. 

Kitchen Antidotes. It must not be forgotten, in a 
sudden call upon the resources of the house in cases of 
poisoning, that there are valuable antidotes in the 
kitchen, such as mustard, salt, warm water, the whites 
of eggs, oil or lard, coffee and tea, soda, chalk, magnesia, 
vinegar, whitewash scraped from the plastering, charcoal, 
etc. For the particular cases in which one or another 
of these is called for, see page 154. 

Bi-carbonate of Soda. Common cooking soda, in 
the treatment of superficial burns and scalds, has a re- 
markable effect in relieving the pain, and in "drawing 
out the fire ," to use a common expression. It may be 
dusted thickly onto the skin, or mixed with water into 
a thick paste and applied, or cloths wrung out of cold 
water in which soda has been dissolved, may be used. 

Epsom Salts, commonly called " salts, " is an excel- 
lent medicine, but to some persons its taste is very 
disagreeable. Its action is quicker and generally better 
than that of pills. A full dose is a tablespoonful dis- 
solved in water ; if a little ginger is added it improves 
the taste and its effect. If the dose is taken just before 
eating it acts more rapidly as a cathartic. In cases of 
habitual constipation, one or two teaspoonfuls taken be- 
fore breakfast every morning generally effects a cure. 



54 



HANDBOOK. 




INJURIES. 55 



PART II. 

INJURIES. 

SHOCK OR COLLAPSE. 

All severe injuries are immediately followed by a 
condition which, in expressive and surgical language, is 
called Shock. In the language of the street, the person 
after receiving such an injury is said to be faint or 
stunned. 

Shock is a sudden depression of the nervous system, in 
consequence of which the action of the heart and the act 
of breathing are weakened, or may be brought to a stand- 
still. When shock is severe, it is the first thing to claim 
the attention of the impromptu surgeon. In mild cases 
the person looks pale and seems faint ; but it is only tran- 
sient, and he soon rallies. When shock is very severe, 
the face and the skin generally become deathty pale and 
cool, and are bathed in perspiration ; the eyes are dull 
and motionless ; the breathing is slow and sighing ; the 
pulse at the wrist may be imperceptible, very weak, or 
rapid ; consciousness is not generally lost. If the patient 
rallies from this critical condition, nausea and vomiting 
usually occur, which are consequently regarded as favor- 
able signs. Fright, the thought of a surgical operation, 
any powerful mental impression, the sight of blood, 



36 HANDBOOK. 

severe pain, and many other causes, are sufficient to bring 
on a condition of shock in persons of a sensitive nervous 
system. Shock in its severest form follows gunshot 
wounds, railroad injuries, and injuries attended with 
great loss of blood, crushing of limbs, penetrating 
wounds of the abdomen and chest, and blows upon the 
head and upon the pit of the stomach. 

There is a great difference in persons in their ability to 
bear injuries or pain. In some a slight wound or acci- 
dent is followed by severe shock. The aged ralty more 
slowly from shock, but do not show its effects so quickly. 
Drunkards bear a shock poorly ; they either die, or may 
fall into delirium tremens in case the injury is severe. 

Treatment: Something must be done, and somethings 
must not be done, or the injured may die simply from 
the Shock of an injury. But few persons outside the 
medical profession are aware of the danger which threat- 
ens the patient from this direction. The patient should 
immediately recline with his head quite low. The first 
thing to do is to restore the failing circulation of the 
blood, and strengthen and keep a-going the act of breath- 
ing. Fortunately, one of the best and most effectual 
remedies is usually at hand ; namely, dry heat. This lias 
an immediate and stimulating effect on the circulation. 
When the patient's skin is pale and clammy, his pulse 
very weak or imperceptible at the wrist, his face haggard 
and eyelids drooping, the immediate application of 
external heat is the first and plainest thing to be done. 
Bottles or cans of hot water, heated flannels, hot soap- 



INJURIES. Di 

stones or bricks properly wrapped should be placed 
around the body, or any other convenient means of 
restoring warmth to the body may be employed. If at 
hand, and the patient can swallow, a small quantity of 
stimulating drink may be given, but not too much, for it 
would be positively harmful. Strong coffee or tea is 
better than nothing. A few drops of spirits of camphor 
in sweetened water, or half-teaspoonf ul doses of aromatic 
spirits of ammonia in sweetened water, would be of 
benefit. There are many cases of shock without loss of 
blood, but when hemorrhage is one of the causes, the 
case is one of great danger, and care must be taken not 
to move the person too soon for fear of a return of the 
bleeding and fatal results from Collapse. 

A surgeon of high authority states that Shock is the 
most common cause of death occuring soon after an 
injury ; from this we can see the importance of prompt 
and well-directed treatment, and that people should 
understand just what should be done. 



58 



HANDBOOK. 



TRANSPORTATION OF INJURED PERSONS. 

Large cities maintain ambulance services for moving 
the injured to their homes or to hospitals ; in country 
towns some improvised method must be devised and 
carried out, often by those inexperienced in such work 
Of course the principal thing is to move the patient with 




as little harm or suffering as possible, and when bones 
are broken, to prevent further displacement or injury. 
We offer a few practical hints on this subject. 

1. If the patient is conscious and able to walk, assist- 
ance may be given if he puts his arms over the shoulders 
and around the necks of two persons, one on either side. 

2. If he cannot walk he may be carried by two assist- 



INJURIES. 59 

ants in the manner illustrated in the above cut, from 
Dr. Dulles' work on Emergencies. 

3. An improvised stretcher, such as a window-shutter, 
door, a board, or two poles passed through coats, the 
coats being buttoned, may be used. Stout blankets, 
shawls, or mattresses make good stretchers. Ingenuity 
will suggest at the time and on the spot other means, 
when any of these are not at hand. It is not generally 
best to put a person severely injured into a high car- 
riage unless the distance he must be carried is very long. 
It is better to transport him on stretchers. 

4. If you are alone, and it is necessary to move an 
unconscious person immediately, as for instance one 
suffocated with smoke, raise the person to a sitting 
posture, place your right shoulder against the lower part 
of his abdomen, grasping with your right arm his thighs 
just above the knees, then rise, allowing the patient's 
head and trunk to hang down over your back, balancing 
the body with your right arm. 

In case of broken bones, before attempting to move 
a patient, if it is thought the bones of the arm or leg are 
broken, temporary splints should be applied to prevent 
further injury. Such splints may be put on over the 
clothing, and may be made of anything at hand, such as 
a thin and narrow piece of a box cover, any stick, a cane, 
etc. The limb should be straightened by a little trac- 
tion, the splint placed on and held in position by tying 
handkerchiefs or strips of cloth around, or if nothing 
else is at hand, the lining from a coat torn into strips. 



60 HANDBOOK. 

Whatever is used, the splint must be firmly bound on in 
several places to prevent any bending or motion of the 
broken limb. When one leg is broken or crushed, it is 
advised that it be bound firmly to the well leg, which 
then acts as a splint. 

It should be remembered that there is danger in mov- 
ing patients too soon after severe hemorrhage from 
wounds, or from other causes. Proper time should be 
allowed for firm clotting to take place in the arteries. 
When the hemorrhage is only slight the danger is nothing. 
If it is necessary to move a person who is very sick 
and weak from one room to another, it can be easily and 
safely done by allowing the patient to remain in a re- 
clining position, and carrying him on stout blankets or 
on a mattress. This needs four assistants. In cases of 
shock and apparent death, valuable time must not be 
lost in moving the patient from one place to another 
before attempts at restoration are made. Artificial 
respiration should be tried, and other restoratives, such 
as warmth and stimulants used, if at hand. The critical 
time in which life could be saved might pass while stop- 
ping to transport the patient to his home or to a hospital. 



INJURIES . 61 

HEMORRHAGE OR BLEEDING FROM WOUNDS. 

HOW TO STOP IT. 

Profuse bleeding from wounds, in cose one of the 
larger arteries of the leg or arm, for instance, has been 
cut or injured, is one of the alarming and dangerous 
accidents of life. Of course in severe cases a messenger 
will be sent for a surgeon, but unless some one with a 
cool head immediately undertakes well directed means of 
checking the hemorrhage, the surgeon may find on his 
arrival that the pale messenger of death has preceded 
him. 

In studying the treatment of hemorrhage from wounds, 
it should be thoroughly understood in the first place that 
the bleeding may be from three different sources : * 

1. From wounded arteries. 

2. From wounded veins. 

3. From wounded capillaries. 

1. When bleeding proceeds from wounded arteries, it 
leaps out of the wound in interrupted crimson jets, or 
wells up at each beat of the heart. 

2. When from the veins, it flows in steady and darker 
colored currents. 

3. When from the capillaries, there is oozing of blood 
from the wounded surfaces. In ordinary wounds the 



* The course of the circulation of the blood is this :the heart, situated in the 
left side of the chest, acts as a force-pump and propels the blood through the 
strong tube-like arteries to every part of th" body; in the tissues minute arte- 
ries intermingle with minute veins which form the capillary Circulation; the 
blood returns slowly to the right chamber of the heart through the veins. 



62 HANDBOOK. 

bleeding comes from all three sources. Bleeding from 
arteries is the most dangerous because the blood is 
forced through the arteries at each beat of the heart, 
which acts on the principle of a force-pump. 

More blood can be lost without a fatal result than is 
generally supposed. In a person weighing 150 lbs. 
there are from 14 to 16 pints of blood. One pint caught 
on cloths or mixed with water seems a large amount, 
and bystanders are apt to say the person has lost 
nearly all his blood. In some cases nearly one-half the 
blood can be lost and the patient rally, but not generally. 

If the face, lips, ears and skin generally are pale, and 
bathed in cold sweat ; if the countenance is vacant and 
the pupils dilated ; and if the person complains of a 
thick mist before the eyes, with flashes of light, and 
hears roaring or humming noises, and faints ; if the 
breathing becomes sighing and the voice small and 
whispering, the pulse quick, fluttering or imperceptible 
at the wrist, the patient is in great peril, though it is 
possible he may rally. A person in this condition should 
not, in any event, be quickly raised to a sitting or stand- . 
ing position ; there would be great danger of death from 
fainting or heart failure. The principal ways and means 
of stopping bleeding from wounds are as follows : 

1. Capillary hemorrhage soon stops of itself. 

2. Bleeding from large wounded veins may require 
treatment, but the case is much less urgent than that from 
arteries. The veins carry blood to the heart, and are 
supplied with valves which allow the blood to flow only 



INJURIES. 68 

in one direction. The current is slow and flows out of 
the wound in a steady stream and not in jets. Pressure 
upon the edges of the wound stops this kind of bleeding, 
because when the walls of these vessels are pressed to- 
gether the blood cannot flow through and clotting soon 
takes place. A compress, which is a piece of folded 
cloth tightly bound down with a bandage, will generally 
control this hemorrhage. 

3. Arterial hemorrhage is by far the most rapid and 
dangerous kind of bleeding in case large arteries have 
been wounded. It is easily known from the other forms 
by noticing that the blood comes in jets at each beat of 
the heart, and that it is bright red in color, compared 
with venous blood in the wound. The following are the 
different wnys of controlling it. 

a. In ordinary wounds in which the smaller arteries 
only are cut, if the bleeding is troublesome, cold water 
or iced- water poured upon the wound is the best means 
of checking it. Hot water, as hot as the hand can bear — 
115° to 125° — lias about the same effect, and is often used 
by surgeons. Tepid water increases the hemorrhage. 

b. When the bleeding is profuse, until other means 
can be used make firm pressure with the fingers and 
thumbs on each side of the wound, the same as one would 
pinch together the end of a rubber tube to prevent water 
from running through it. This closes the ends of bleed- 
ing arteries. 

c. A Spanish Windlass may be used in this way : tie a 
hard knot in a handkerchief, suspender or cord, then tie 



64 



HANDBOOK. 



Tb loosely around the limb above the wound ; slip a stick 
cnrough tne loop and twist it round and round, keeping 
tue kuot over the bleeding artery. This operation has 
saved many lives. It acts on the same principle as the 
tourniquet which surgeons use. 

d. Firm pressure with the fingers down upon the 
bleeding artery above the wound is a ready and natural 
way of checking profuse arterial hemorrhage from wounds 
in the limbs. The main artery of the leg passes down 
on the inside of the thigh, and that of the arm, on the 
inside of it. With the fingers search for these arteries, 

known by their beating, 
then press them firmly 
against the bone of the 
thigh or arm ; this closes 
the walls of the artery so 
that the blood cannot flow 
out. The limb should be 
elevated above the body 
in all cases, for it some- 
what lessens the force of 
the blood pressure. Some 
distinguished surgeon has 
said that he did not fear 
hemorrhage from an ar- 

Fressing an artery to arrest hemorrhage, tery that he COllld lay hlS 

linger upon. This metnod is illustrated in the accom- 
panying cuts, the dotted lines representing the line of the 
arteries. 




INJURIES. 



65 



e. It mast be remembered that nothing is absolutely 
safe till a ligature (a thread) is tied around the end of 
the bleeding artery, 
if it is a large one. 
Perhaps it is hardly 
to be expected that 
any non-medical 
person would under- 
take an operation of 
this kind, but one 
might in a gieat 
emergency, and to 
save life, as it is not 
difficult in itself. In 
a large wound the 
end of the artery can 

be Seen, looking like Pressure upon the artery to stop hemorrhage. 

the end of a whip-cord ; seize it with a pair of tweezers 
or with a wire bent up, pull it out and tie a silk or linen 
thread firmly around it. 

Styptics or astringent substances used locally to stop 
bleeding are sometimes useful in the smaller wounds, 
but not safe when large arteries are wounded. The 
most reliable styptics are alum, perchloride of iron, ma- 
tico, tannin and vinegar. Lint or absorbent cotton 
bound onto the wound helps to stop the bleeding and to 
clot the blood in small wounds. 

Summary. — The distinction between bleeding from 
arteries and that from veins should be remembered. In 




66 HANDBOOK. 

ordinary small wounds the hemorrhage stops in a brief 
time ; if not, a little lint tightly bound on with a bandage, 
or a little ice-water or hot water poured upon the wound 
is sufficient to control it. In large and deep wounds in 
which large arteries are cut off the treatment must be 
different ; pressure, either directly upon the edges of the 
wound or upon the bleeding artery above the wound, 
with the fingers or with an improvised tourniquet (hand- 
kerchief or cord twisted down upon the limb) is an 
effectual way, generally, of staying the flow. If it does 
not, the bleeding artery must be tied or ligated. Bleeding 
from veins is usually easily controlled by pressure with 
the fingers upon the edges of the wound, or by binding 
a compress tightly on with a bandage. It must be 
remembered that after the bleeding is checked the part 
must not be moved for fear of starting it afresh. 



INJURIES. 67 



WOUNDS. 

THEIR MODERN TREATMENT. 

Surgeons recognize only two principal ways* in which 
all wounds heal, namely : 

1. Healing by primary union or by first intention. 

2. Healing by second intention or by granulation. 

1. Healing by first intention takes place only when 
the wound is a clean cut and when its sides and edges 
are brought close together and kept so. The wound 
must be free from large clots of blood, or other foreign 
substances. It is the quickest way in which wounds can 
heal. Nature throws out from the fresh-cut surfaces a 
plastic material which glues them together in one or 
two days, leaving only a small scar. 

2. Healing by second intention or by granulation. 
This is the process nature takes when a wound is left to 
gape or when the flesh is torn or partly destroyed. It 
means that new flesh is filled in particle by particle. It 
is a slow process ; suppuration takes place and a large 
scar remains, but by necessity it is the only way in 
which many wounds can heal. If a torn wound or a 
deep burn is examined while healing, the small red gran- 
ulations can be easily seen ; when the granulations are 
overabundant they are called " proud flesh." Most 



* Two other ways are sometimes described, namely : healing by Immediate 
Union, and healing by Scabbing. These are so rare that they are of no prac- 
tical importance. 



68 HANDBOOK. 

persons think that some healing salve, balsam, liniment 
or wash is required to make a wound heal, but nature 
must heal all wounds when they heal at all. The artful 
hand of man can only furnish the favoring conditions. 
The true doctrine of the healing of wounds is quaintly 
expressed by that great quack doctor, Paracelsus, in his 
" Great Surgery, " printed in the year 1536. 

" Warily must the surgeon take heed not to remove or 
interfere with nature's balsam, but protect and defend it 
in its working and virtue. It is the nature of flesh to 
possess in itself an innate balsam which healeth wounds. 
. . . Inasmuch as flesh forms from within outwards, 
and not from without inwards, so the surgery of wounds 
is a mere defensive to protect nature from suffering any 
accident from without, in order that she may proceed 
unchecked in her operations. " 

The most popular modern treatment of wounds at the 
present time is called 

The Antiseptic Method. — This is founded on the 
belief that the air contains germs which are poisonous 
to all wounds. These germs, called by scientific men 
bacteria, are not visible to the naked eye, but are 
visible through the powerful eye of the microscope ; 
on this account they are often called Micro-organisms. 
When these minute living things find a lodgement in a 
wound, they increase rapidly in numbers, induce pu- 
trefaction and prevent the wound from healing so 
kindly as it otherwise might. These invisible germs not 
only float in the air, but they cling to the hands, to old 



INJURIES. 69 

sponges and rags, to instruments and to other things 
used about a wound, and thus get into it. 

It has been discovered that certain substances have 
the power of killing or rendering inactive these poisonous 
germs, thus preventing putrefaction or blood poison- 
ing, and favoring the natural and more rapid healing of 
wounds. Such substances are called Antiseptics. 
Among these are Corrosive Sublimate, Carbolic Acid, 
Iodoform, Alcohol, Sulphur, Borax, Common Salt and 
Vinegar. 

Corrosive Sublimate is extensively used by surgeons as 
an antiseptic, but it is too poisonous for everybody to use. 

A solution of Carbolic Acid is an excellent antiseptic 
for ordinary use in the family. Alcohol, with one or 
two parts of water, is an antiseptic. 

Sulphur is considered by many one of the best agents 
of this class. 

Iodoform, which comes in the form of a yellow powder, 
is a new antiseptic which surgeons in hospitals and in 
private practice are using the world over. It possesses 
wonderful powers in curing foul ulcers and old sores 
principally on account of its germ destroying property. 
It is dusted upon wounds or sores and covered with lint ; 
or an ointment may be made by mixing it with cosmoline 
or vaseline. 

Powdered Borax. — Dissolve two teaspoonfuls in a cup 
of water. This may be used when nothing better is at 
hand. 

The aim of this method is to keep the wound, from the 



70 HANDBOOK. 

first, absolutely free from these micro-organisms or germs. 
The practical part of it can be carried out by cleansing 
wounds before dressing them with some one of these 
solutions above named. 

It may be said in a general way that the most import- 
ant thing in the treatment of cuts, after stopping the 
bleeding, is to cleanse the wound thoroughly with some 
antiseptic solution, then bring its sides and lips close 
together and hold them in place with strips of adhesive 
plaster or stitches, and a bandage, and to keep the part 
at perfect rest. 

Large lacerated or torn wounds are best treated at 
first with the hot water dressing. Nothing has yet 
been found which so well prevents undue inflammation 
and the attending pain and swelling. Antiseptic pre- 
caution should be taken. For trivial wounds carbolized 
vaseline or cosmoline makes a good dressing, for it pro- 
tects the wound from the air, friction, and dirt. A little 
adhesive plaster is all that is needed in many cases. 

For the sake of convenience in description, surgeons 
divide wounds into Incised, Lacerated, Punctured, Gun- 
shot and Poisoned. 

Incised Wounds or Cuts are those made with sharp 
instruments. When properly treated they are the best 
wounds to heal. Of course they vary in size from a 
trivial cut to a most formidable looking wound, but in 
the latter case one should not despair of undertaking the 
first and proper treatment in the absence of a surgeon. 



INJURIES. 



71 



Treatment. — Small cuts are best treated — after the 
hemorrhage is stopped — by drawing the wound close to- 
gether with adhesive plaster, if it is at hand ; if not, dress 
with cosmoline or any simple salve to protect from dirt 
and friction. Before dressing large wounds, cleanse 
with some antiseptic solution such as carbolic acid ; next 
draw the sides together and keep them so with the best 
means at hand. Sur- 
geons' adhesive plas- 
tet, cut into long, 
narrow strips, is well 
adapted to hold the 
sides of a wound in 
apposition. The ac- 
companying figure 
illustrates the man- 
ner of applying the 
plaster-strips. 

First, firmly place 
one end of a strip 

On One Side Of the Propei . m . llJ1K . r of applying Adhesive Plaster to 

wound, draw the a lar ^ e cut - 

wound together, then stick the other end down, and so 
on till all the strips are fixed firmly in place, being 
sure to leave a little space between them for the 
escape of discharges. Most persons who have not been 
instructed in this matter stick on a large piece of the 
plaster, completely covering the wound ; a few drops of 
blood escaping loosen the plaster and leave the wound 




72 HANDBOOK. 

gaping. A piece of soft cloth or lint may be placed 
over the plasters, and then a bandage so applied as to 
help in keeping the wound pressed together. The strips 
may be removed the third day. Moisten them with warm 
soapy water, and pull each end towards the wound. 
After the plasters are removed, cosmoline, vaseline or 
even mutton tallow makes a good dressing, when applied 
on a soft cloth, to prevent friction and injury to the heal- 
ing wound. What shall be done if adhesive plaster cannot 
be obtained? If the wound is large and gapes, some one 
with a little courage should be found who will take a 
few stitches to close it. A common needle with silk or 
linen thread will do. If it cannot be sewed up, a bandage 
may, sometimes, be so applied as to close the wound, or 
the part may be placed in such a position before band- 
aging as to favor closing it. All large wounds should 
be kept quiet for a number of days to insure rapid heal- 
ing. It sometimes happens that a wound does well for a 
few days, then from taking cold in it, or from irritation 
and over use, pain, redness and swelling begin. The very 
best treatment in such cases is to apply a hot poultice 
with a little laudanum poured upon it, if it is at hand. 
This prevents the threatened inflammation. 

Fingers and Toes Cutoff. — If found immediately, they 
should be put back in place after being cleansed, and kept 
warm till a surgeon arrives, who may think best to sew 
the part on with the hope that healing may take place. 
If a small part of the skin remains not cut off, the 
chances of healing are good, when properly treated. 



INJURIES. 73 

This treatment applies only to fingers and toes cut off 
with sharp instruments ; when they are torn off, there is 
no chance that they will heal or " grow on. " 

Cuts of the Face require skilful treatment in order 
to prevent disfigurement from ugly scars. Clean cuts 
should be accurately closed, and generally should be 
sewed up with fine stitches. It is difficult to apply 
adhesive plaster on the face so as to prevent gaping of 
the wound. On this account, even if the wound is not 
very extensive, a surgeon should be called. 

Cut Wounds of the Scalp. Plasters cannot be applied 
here unless the hair is shaved off. A few stitches are 
needed to close large wounds. Some surgeons advise 
that small locks of hair on either side of the wound be 
waxed, and with these the wound tied together. Bleed- 
ing is apt to be free, but it may be controlled by press- 
ing the edges of the wound against the skull bones. 

Cuts or Stabbing Wounds of the Abdomen or Chest. — 
If the abdominal walls, or the walls of the chest are cut 
through, allowing a part of the bowels, or, in the latter 
case, a part of the lungs to escape, they should at first 
be covered with some soft cloth wet in warm water, and 
kept warm till they can be returned by skilful hands. 

Cut Throat Wounds do not often prove fatal. The 
blood-vessels of the neck are so deep, and the windpipe 
is so difficult to cut through, that life is, in this way, 
fortunately saved. If there is much hemorrhage, cloths 
wrung out of iced-water must be pressed firmly into the 
wound, and the head bowed forcibly forward upon ike 



74 HANDBOOK. 

breast. In this way, pressure is made upon the bleeding 
vessels, and somewhat checks the hemorrhage till skilled 
assistance is obtained. 

Punctured Wounds are those made with pointed 
instruments, such as knives, needles, nails, pitchfork 
tines, etc. The chief danger from such wounds is that 
pus or matter may collect in the deep part of the 
wound, where it cannot get veat. Some surgeons slit 
such wounds open, thus converting them into clean cuts, 
which they find no difficulty in healing. People think 
there is great danger of lock-jaw from punctured wounds, 
especially those made with rusty nails. The chances of 
this, however, are rather small. The only bad thing about 
a rusty nail is, that it carries into the wound more rust 
and dirt than cleaner instruments do. 

Treatment. — The important point in the treatment of 
all punctured wounds, is to try and prevent the healing, or 
sticking together of the external lips of the wound till 
healing has taken place within. A small piece of lint 
may be stuffed into the external wound to keep it open 
till the deep part is healed. 

A puncture made with a sharp instrument should be 
so bandaged that the sides of the wound are closely 
pressed together, when healing through the entire extent 
will rapidly follow. If, after a day or two, punctured 
wounds become angry, swollen and painful, they should 
be poulticed, or freely opened, if there are signs that maty 
ter is pent up within. 



INJURIES. 75 

When the flesh has been deeply punctured or pricked 
with some small instrument like a rusty tack, small nail, 
dirty splinter or penknife, or anything irritating or poison- 
ous, redness, swelling and pain sometimes result. It 
happens in this wa} T : the skin, being elastic, immediately 
closes, leaving inflammatory products tightly bound in 
beneath. If neglected, considerable trouble may arise. 

"When pain and redness first appear, cloths wrung 
out of ice-cold water should be immediately applied, or 
hot poultices with laudanum or arnica poured upon them 
may be used. If matter collects it should be let out at 
once. 

Fish-hooks and Needles make punctured wounds which 
soon heal. Needles are easily extracted when they are 
not broken off. To find and get out a small piece of a 
needle is a very discouraging undertaking. They may re- 
main in the body a long time and give no trouble. They 
often travel long journeys through the body. 

Fish-hooks are difficult things to get out unless one 
goes to work the right way. Grasp the hook firmly, and 
with a quick motion pull it entirely through till the 
barbed end projects above the skin. If a small file is 
at hand, either end of the hook can be notched and 
easily broken off ; then the hook is readily taken out. 
If the line-end is small, it can be pulled through without 
trouble. 

Splinters and Thorns. — These can generally be pulled 
out with a pair of tweezers ; if not, poultice the part to 
hasten suppuration, when they can be removed easily. 



76 HANDBOOK. 

Splinters driven up under the nails are painful things. 
By cutting a little notch in the nail, they can usually be 
removed ; if not, scrape the nail over the splinter with a 
sharp knife or with a piece of glass till it is very thin, 
then with a very sharp knife cut down upon the splinter 
and remove it. Small punctured wounds are often on 
the hands. To cover them with good adhesive plaster 
is the best treatment. It keeps dirt from the wound and 
prevents irritation. If one " gets cold" in these punct- 
ured wounds, the best treatment is to apply hot poultices 
with a little arnica or laudanum upon them. 

Gunshot Wounds are sometimes seen in civil life 
as the result of carelessness in handling fire-arms, or in 
shooting affrays. 

It is something of a comforting thought, to one who 
has had a bullet lodged in his body, to know that if it 
cannot be easily extracted there are a good many chances 
that it may give no trouble, or that it may in time come 
to the surface, when it can be easily removed. 

Treatment. — Many skilful surgeons at the present day 
do not think it advisable to explore extensively for a 
bullet, unless it gives great trouble. If it is lodged just 
under the skin, it can be picked out after cutting through 
the skin. There is no calculating in what place a bullet 
may be that has been shot into the body ; it glances in 
unexpected directions. A careful examination of the 
skin should be made to find whether the bullet has 
passed out or not. The wound must be examined 



INJURIES. 77 

carefully for any pieces of clothing, wadding, or other 
things which may have been carried into it, and these 
things removed. The wound should then be thor- 
oughly syringed or drenched with a solution of carbolic 
aeid or other antiseptic ; after this, the very best 
treatment is the application of the hot water dressing 
which allays pain and prevents inflammation. 

Powder in the Skin. — By the explosion of powder, 
unburnt grains of it are sometimes lodged in the skin of 
the face. . There is no other way of removing except by 
patient work with the sharp point of a penknife or lan- 
cet, picking out particle by particle. Small shot in the 
skin must be removed in the same way. 

Poisoned Wounds are those made by rabid ani- 
mals, venomous serpents, scorpions, centipedes, bees, : 
hornets, spiders, insects, etc., or by any poisonous sub- 
stances introduced under the skin. The treatment of 
the bites of rabid animals is described in an article to 
follow . 

Treatment. — If the wound is small, such as the stings 
of insects, bees, hornets and wasps, the bites of spiders, 
etc., and there is great pain and swelling, the applica- 
tion of a solution of aqua ammonia, soda or carbolic 
acid is of much benefit. In some cases ice seems to be 
best. Hot poultices moistened with laudanum have a 
good effect. A pinch of salt dampened and rubbed in is 
useful. It is said that a slice of onion rubbed on gives 
instant relief for small stings. 



78 HANDBOOK. 

The bites of flies sometimes make poisonous wounds 
if they have just come from eating putrid matter. Wash 
them with carbolic acid and apply a poultice. If one 
has been bitten by a rattlesnake, it is advised that the 
fold of skin containing the puncture be taken into the 
mouth immediately and strong suction made. If there 
is no sore on the lips or in the mouth, this can be done 
without harm. Large drinks of alcoholic stimulants to 
prevent dangerous depression are recommended. In the 
treatment of the bites of venomous serpents, some sur- 
geons think it best to cut the wound out immediately. 
A cord or handkerchief should be instantly tied around 
the limb above the wound to prevent absorption of the 
poison, then if one has the grit to bear it, and anyone 
is at hand who has the courage to do it, it may be done. 
The next safe thing is to burn the wound out with a red- 
hot wire or with lunar caustic. After this a poultice 
should be applied. 

Large poisonous wounds or bites must be treated 
locally the same as directed in cases of rabid animal 
bite? . 



INJURIES. 79 



THE BITES OF MAD DOGS. 

HYDROPHOBIA. 

We begin with a protest against the common but fool- 
ish practice of killing a dog immediately after he has 
bitten a person, because somebody says he is mad. Per- 
haps the dog is not mad, but who will know if he is imme- 
diately killed? Put him in some safe place at once, and 
watch developments. If the animal remains well, eats 
well, drinks well, looks sleek and seems happy, what a 
load of fear, anxiety and horror would roll from one's 
mind when assured by this continued health that the dog 
which had bitten him was not mad. Dogs really rabid 
die in from four to eight days from the beginning of the 
disease. On the other hand, if the dog had been killed by 
the law of custom, the wound would be watched, and 
afterwards the scar, for months, with fear and uncer- 
tainty. Nor is this all. Surgeons think that many die of 
fright who are supposed to die of Hydrophobia. An ordi- 
nary tooth wound may not heal well when the patient is 
very frightened about it ; his mind is constantly centered 
upon it day and night ; he is robbed of sleep and appetite 
for food ; he becomes weak, and nervous spasms easily 
set in, which he and his frightened attendants allow are 
those of the dreaded disease. When once begun, the 
extent to which nervous disturbances may go is truly 
wonderful. Cases of spurious Hydrophobia may happen 



80 HANDBOOK. 

in this way. As mad-dog-scares are common, a brief de- 
scription of the symptoms of real canine madness may 
not be out of place here. The disposition and habits of 
the dog are changed ; he may seem fond of his master 
for a few minutes, but soon is sullen and suspicious ; he 
mopes about and avoids society, or hides in dark corners ; 
his appetite becomes depraved, sometimes very greedy ; 
he chews various things not food ; he looks haggard, 
and his eyes are perhaps bloodshot, or have lost their 
natural expression. When quiet, his breathing is unnat- 
urally rapid and labored. The bark is uttered in a 
hoarse, rough tone. The dog may soon show a dis- 
position to snap at other dogs or at surrounding objects, 
without provocation, and contrary to his former habits. 
In the later stages of the disease, ropes of saliva hang 
from his mouth, and his lower jaw is dropped. He has a 
fear of drinking water after one or two trials at it. In 
the furious stage, the animal runs wildly around, snapping 
at everything, even at imaginary objects, with a peculiar 
hoarse bark. He lives from four to eight days. 

The celebrated veterinary surgeon, Youatt, graphically 
describes the early symptoms in a dog about to run mad 
in the following language : 

" In the greater number of cases there are sullenness, 
fidgetiness and continued shifting of position. When 
I have had opportunity I have generally found these 
circumstances in succession. For several successive 
hours perhaps he retreats to his basket or bed. He 
shows no disposition to bite, and he answers the call 
upon him laggardly. He is curled up and his face is 
buried between his paws and his breast. At length he 



INJURIES. 81 

begins to be fidgety. He searches out Dew resting 
places ; but very soon changes them for others. He 
takes again to his own bed ; but he is continually 
shifting his posture. He begins to gaze strangely about 
him as he lies on his bed. His countenance is clouded 
and suspicious. He comes to one and another of the 
famity and fixes on them a steadfast gaze as if he would 
read their very thoughts. ' I feel strangely ill, ' he 
seems to say, ' have you anything to do with it? or you? 
or you ? ' 

"Has not a dog mind enough for this? If we have 
observed a rabid dog at the commencement of the 
disease, we have seen this to the very life. " 

The same writer further says : 

"The sullen form is characterized by shyness and 
depression in which there is no disposition to bite, and 
no fear of fluids. The dog appears to be unusually 
quiet, is melancholy, and hna depression of spirits; 
although he has no fear of Water, he does not drink. 
The fear of water (which the word Hydrophobia means) 
it should be said, is acquired by experience, the effort 
of swallowing being attended with spasm of the muscles 
of the throat. " 

It is a comforting and an important thing to know 
that the bite of a rabid animal is not always followed by 
Hydrophobia, for these reasons : 

First. When the bite is through clothing, as it often 
is, the poisonous saliva is wiped from the teeth by the 
clothing. 

Second. When the skin is only grazed the poison will 
not be absorbed as a rule. 

Third. When the bite is on uncovered parts it may 
not, for some inexplainable reason, be followed by Hy- 
drophobia. 



82 HANDBOOK. 

Treatment. — What can be done immediately when one 
is bitten by a rabid animal? 

First. — If the wound is on a limb, tie a cord or hand- 
kerchief tightly around it above the wound. This pre- 
vents, to some extent, the poison from entering the cir- 
culation. 

Second. — Apply suction to the wound, either with the 
mouth or with a cupping-glass, to draw out all the poison 
possible. 

Third. — If carbolic acid is at hand, dip a little stick in 
it repeatedly, and touch the acid upon all parts of the 
wound. This is easily done, and many surgeons think 
it is the best of all possible treatment. The wound may 
be cauterized with nitrate of silver (lunar caustic) , or, 
if the patient has the grit to bear it, burn it out with a 
red-hot wire ; or cut the wound entirely out. After 
the wound is cauterized apply a poultice to relieve pain 
and to encourage suppuration. This is about all that 
can be done, even by a surgeon, unless the patient 
crosses the Atlantic, where he can be treated by the cel- 
ebrated method of M. Pasteur, of Paris. 

A sensible surgeon says : 

" In case of a bite from a supposed mad dog, let the 
things suggested above be done ; then let quiet be se- 
cured and the very best medical man in the place sent 
for. It is a very serious matter, and calls for the 
clearest head and most extensive information. Whoever 
gets flurried at such times is scarcely less dangerous than 
the dog that- did the biting. Then let no one breathe 
Hydrophobia or talk about what has happened. By this 
the chances of escape will be increased. " 



INJURIES. 



83 



Since writing the above, a Pasteur Hospital has been 
established in N. Y. City for the treatment of Hydro- 
phobia. This method consists of repeated inoculations 
with the hydrophobic poison, at first attenuated, after- 
wards increased in strength, until the system is able to 




Louis Pasteur of Paris, inventor of a method of inoculation to prevent 
Hydrophobia. 

resist the disease. It is claimed by its distinguished 
discoverer, that if this method is followed soon after the 
bite, the person is so ''protected" that he will escape 
the real disease. If the whole truth is spoken, it must 
be said that many surgeons in this country and abroad 



84 HANDBOOK. 

have doubts about the genuine protection which is 
claimed for this method ; the chances in its favor are, at 
least, enough to demand a thorough and continued trial 
of it ; time will determine its real value as a preventive 
of this terrible disease. 

Lacerated or Contused Wounds are tears or 
bruises of the flesh, the edges of which are more or less 
ragged and irregular ; they differ from clean cuts in 
being much less apt to bleed profusely ; they are less 
painful, but require a much longer time to heal. They 
must heal by granulation or second intention. In larger 
wounds suppuration (the formation of matter) generally 
takes place. 

Treatment. — Small wounds after being cleansed, may 
be dressed with a little cosmoline, covered with lint and 
secured with a bandage ; or strips of adhesive plaster may 
be used to draw the ragged wound together as much as 
possible, and protect it from dirt and friction. Large 
lacerated wounds should first be cleansed of all foreign 
matters, then washed in a solution of carbolic acid, 
dilute alcohol, or if nothing better is at hand, in sulphur 
or borax and water (after the antiseptic method), then 
apply clean cloths wrung out in hot water till a surgeon 
arrives. If the wound is not very large, it is well treated 
by a dressing of clean lint with a little carbolized cosmo- 
line or even mutton tallow spread upon it. If at hand, use 
strips of sticking plaster to draw the wound together ; 
apply a pad and retain in place by a roller bandage. 



INJURIES. 85 

Crashed, Fingers and Toes. — When the bones are not 
broken, press or mould into as natural shape as possible 
and " dress inathe blood ; " that is, bandage before bleed- 
ing has entirely stopped ; the blood and bandage, when 
dried, make a protective casing, while nature glues the 
flesh together. If the bandage becomes too hard, it may- 
be softened by pouring upon it arnica or dilute alcohol. 
The second day remove the bandage by soaking it in 
soap and water, and apply adhesive plaster. 

Crushed Hands, Feet, Arms and Legs. — If hemorrhage 
seems dangerous, pour ice-cold water or hot water upon 
the limb. Let the patient lie down and place the limb 
higher than the body. If this does not control the bleed- 
ing, proceed as directed in the article on hemorrhage. As 
soon as bleeding has stopped, wrap the crushed part in 
cloths wrung out in hot or cold water, whichever is most 
agreeable to the patient's feelings, and keep the limb 
elevated till a medical man arrives. 

Contusions. — These in common language are bruises. 
They may be very painful. Blood-vessels are broken 
under the skin allowing blood to escape into the tissues, 
which Is the cause of the varied discoloration which is 
noticed in such injuries. A black eye is a good exam- 
ple. At first cloths wet in iced-water is the best remedy, 
but with some persons hot water is more agreeable ; 
afterwards, pure laudanum, tincture of arnica, or the 
dilute tincture of iodine may be applied with benefit. If 
nothing better is at hand, vinegar answers a good purpose. 



86 HANDBOOK. 



MOSQUITO BITES. 

The poet Bryant in an address to the mosquito begins 
with the followiug plaintive request : 

Fair Insect ! that with threadlike legs spread out, 

Dost murmur, as thou sail'st about; 

Try some plump alderman, and suck the blood 

Enriched by generous wine and costly meat; 

Go to the men for whom, in ocean's halls, 
The oyster breeds and the green turtle sprawls 

A writer in the current number of the North American 
Review states, that one "Dr. Lam born has recently 
offered a prize for a preliminary study of the habits of 
the dragon fly (devil's darning needle) with a view to 
its propagation as a destroyer of the mosquito, and 
that it has found the ready ear of the American nation." 
This seems a large-sized project ; if it succeeds, and 
nearly all the mosquitoes in the country are headed off or 
devoured by a vast army of devil's darning needles, the 
treatment here advised for the prevention or cure of 
mosquito bites will be altogether behind the times. 
Mosquitoes are a great pest in nearly all parts of the 
world ; they are found as far north as Labrador. They 
not only disturb the peace and happiness of the dwellers 
in country houses, but they come swooping down upon 
the innocent inhabitants of N. Y. City, from the low- 
lands of New Jersey, in innumerable armies. These tiny 
creatures have caused the rout of armies nnd the desertion 



INJURIES. 87 

of cities, it is said. The writer visited the famous 
Rangeley Lakes in the northern part of Maine for trout 
fishing and found the bites plent} 7 , but about in this ratio 

1000 : 1 
in favor of mosquitoes. To many persons, especially 
to children, mosquito bites are very poisonous, causing 
inflammation of the skin, with pain and swelling. 

Treatment. — Their presence in sleeping-rooms is most 
annoying. To drive them out of a room, take a piece of 
gum camphor half as large as a hen's egg, place it in a 
basin and hold it over a lamp ; the fumes soon fill the 
room and expel the mosquitoes ; not one will be found 
in it the next morning. 

It is not generally known that the bites of these pes- 
tiferous creatures may be prevented by bathing the ex- 
posed parts of the body, the hands, face, neck, and also 
the hair in a weak solution (5 per cent.) of carbolic acid. 
The pillows in the bed may be sprinkled with the same. 

The solution is either poisonous or very disagreeable 
to these creatures. 

English surgeons highly recommend pennyroyal to 
prevent the mosquito bites. To cure the bites, bathe the 
parts in either a solution of ammonia, bicarbonate of 
soda, bromide of potassium or pennyroyal. Salt mois- 
tened with vinegar is a good remedy. 

If the face or limbs are very much swollen, inflamed 
and painful from the effect of these bites, as they often 
are in children, the application of hot carbolized water 
for an hour or two is the best thing known. 



88 HANDBOOK. 



MACHINERY AND RAILROAD INJURIES. 

The first and most noticeable thing after these severe 
injuries is apt to be the profound Shock from which the 
person is suffering. The appearance of the injured is 
often such that uninformed workmen and bystanders 
might think the person dead when he is not, and when 
he could, with prompt and proper treatment, be rallied. 
On this account we have called attention here to the sub- 
ject of Shock. This condition may be caused by profuse 
hemorrhage, the fracture of bones, the crushing of limbs, 
internal injuries, or simpl} T by a violent disturbance of 
the nervous system. 

Enterprising railroad companies are beginning to see 
the importance of giving to their employes some means 
of instruction as to the prompt treatment of their injured. 
They have put into the hands of their workmen books 
of instruction and cases of medicines, and appliances 
for emergencies. Surgeons cannot always be obtained 
at a moment's notice and in the nick of time when their 
services would do the most good. 

In a machinery accident a man might die in ten 
minutes from hemorrhage, when simple pressure with 
the finger would save his life, if a workman knew where 
to make it. This could be easily learned with a little 
attention. 

The injured person should be placed at once in a re- 
clining posture, and rallied from the shock, then ex- 



INJURIES. 89 

amined. If fractures or dislocations of limbs exist, 
they should be placed in a position as comfortable as 
possible. While waiting for a surgeon, apply cloths 
wrung out of hot water to the injured part, to prevent 
pain and swelling. 

Large lacerated wounds or tears of the flesh must be, 
as soon as possible, washed with warm water, to which 
it is preferable to add a little carbolic acid. All dirt, 
pieces of clothing, splinters, and other foreign substances 
should be at once removed with the best pair of forceps 
at hand, usually the thumb and fingers. Then the very 
best thing to do is to get some soft, clean cloths, satu- 
rate them in an antiseptic solution, and apply till a med- 
ical man arrives. 

If hands, feet or limbs are torn off, the first care will 
be to arrest the hemorrhage. Tie a handkerchief, cord, 
or anything at hand around the stump close to the end. 
This may pinch together the bleeding vessels, and stop 
the flow. Railroad injuries cause very great depression 
of the vital forces ; on this account stimulants are called 
for in severe cases. 

Precautions. — In riding on railway trains select the 
rear cars ; they are safer than those near the engine. 
The rear cars often escape disasters which the forward 
ones do not. If it is known in season that a collision is 
to take place, or that violent commotion is to happen in 
the car, grasp the seat in which you are sitting, and try 
to avoid the danger of being thrown from your place. 
The American Health Association (office at Concord, 



90 HANDBOOK. 

N. H.,) has published a prize essay (price 5c.) on the 
causes of disease, injury and death in American manu- 
factories and workshops, which, in the way of precautions 
against injuries, is profitable reading. 



INJURIES. 91 



INJURIES OF THE HEAD. 

Injuries resulting from blows upon the head or from 
falls are common, and are attended with considerable 
danger. This saying has been ascribed to Sir Astley 
Cooper: "No injury to the head is too slight to be 
despised, nor too severe to be despaired of. " As they 
are common and important we notice here Concussion 
and Comjiression of the brain, and Scalp Wounds. 

Concussion of the brain means a violent shaking up 
or jarring of the brain, in consequence of which some 
part of the brain, its membranes or blood-vessels, may 
be torn ; in other cases the symptoms are simply the 
effects of Shock. 

In mild cases the person is said to be stunned from a 
blow on the head or from a fall ; he feels giddy and con- 
fused, is faint and weak for a few minutes. 

In more severe cases the patient falls to the ground 
half conscious ; he may be aroused for a few seconds 
possibly, but soon relapses into his former state. The 
pulse is feeble, the skin cool and wet with perspiration ; 
the limbs flaccid and motionless ; there may be paralysis 
or convulsive twitchings of some muscles. This is the 
first stage of severe concussion of the brain. 

If the person is about to rally, the circulation im- 
proves, the pulse becomes stronger, and the skin warm ; 
generally the patient vomits, after which he is better. 

In other cases he remains for hours semi-conscious, 



92 HAND HOOK. 

with very feeble pulse, the skin cold and death-like ; or 
death may rapidly follow. 

Vomiting is a symptom of a good deal of significance 
for if the patient vomits it is a sign that he is about to 
rally ; if he does not, it may be known that the injury is 
either very slight, or so severe that lie will probably die. 

Such is the appearance of a person suffering from 
Concussion of the brain. What can be done ? 

Treatment. — The ordinary, less severe cases do not 
require treatment. If marked symptoms of prostration 
are present, something to assist the patient to rally may 
be done. He should recline with the head slightly 
raised. The flagging circulation must be stimulated by 
artificial heat, applied to the skin in any convenient 
way. If the injured man can swallow, give aromatic 
spirits of ammonia, or small quantities of other spirits. 
When reaction takes place, throbbing pain and heat of 
the head may begin ; if it does, apply ice-cold water to 
the head, and give 20 gr. doses of the bromide of potas- 
sium every two hours. Quiet and freedom from all excite- 
ment must be observed. It is well at first, in injuries of 
the head, to give medicine to open the bowels freely. 

Compression of the brain. — We find here a diff event 
condition of things. A blow may fracture the skull, or 
blood may be poured out between the skull and brain, 
forming a clot ; in either case causing pressure upon the 
brain. An external examination may not reveal what 
has happened, but the condition of the injured person 
will plainly show it. He is profoundly unconscious, his 



INJURIES. 



93 



breathing is heavy, and he snores with a peculiar puff- 
ing out of the lips, and his pulse is slow and full. There 
may be convulsions, and possibly bleeding from the ears 
and nose, in fracture at the base of the skull. Nothing- 
can be done except to remove the pressure by the use of 
the trephine in the hands of a surgeon. 

Scalp Wounds are made by things falling upon the 
head, or from blows and cuts ; much greater importance 
attaches to these than to wounds in most other parts. 
Following the teaching of the antiseptic method, surgeons 
now advise that the scalp around the wound be shaved, 
or the hair closely cut, and that it be washed and scrub- 
bed with soap and water containing carbolic acid, to get 
rid of all impurities or germs that might get into the 
wound and cause putrefaction. Perfect cleanliness is 
the important thing. If the scalp is sufficiently shaved, 
sticking plasters may be used to draw the wound 
together ; or it may be dressed with clean lint or cloth 
with carbolized cosmoline spread upon it, covered with a 
pad, and the whole kept in place by a bandage around 
the head. 

If inflammation should begin in the wound, that is, if 
it becomes red and painful, an attempt should be made 
to limit it by applying ice-water, which is probably the 
most reliable remedy ; if one objects to its use, hot water 
or poultices may be substituted. A seidlitz powder 
should be given for its mild action upon the bowels. 

If the scalp is torn down in strips, or partly torn off 
from the skull, it should be thoroughly cleansed in some 



94 HANDBOOK. 

antiseptic solution, and immediately put back in place ; 
it is truly surprising how readily it heals on in young 
and healthy subjects. 

Precautions. — If a person is obliged to drop or jump 
from a height, he should alight on the balls of his feet 
with the knees bent. Striking upon the heels might 
©ause a concussion of the brain or of the spine. If rid- 
ing in a runaway team, the safer thing, generally, is to 
cling to the carriage. Jumping from the carriage while 
in rapid motion is dangerous ; concussion of the trfsin 
is often the result. 



INJURIES. 95 



BROKEN BONES OR FRACTURES. 

Fractures are either simple or compound. In a simple 
fracture the bone only is broken. A compound fracture 
is so called because the bone and the skin are both 
broken ; the ends of the bone may be driven through the 
skin so as to be seen. A compound fracture is a seri- 
ous matter, as it is difficult to heal. The following signs 
show that a bone is broken. 

1. The limb is deformed, or changed in its shape com- 
pared with the well one. 

2. The limb is unnaturally moveable at the place of 
fracture. 

3. Grating may be heard and felt when the limb is 
moved or slightly twisted. 

4. A broken limb is usually shorter than its fellow, 

5. The ends of the broken bone may be felt when the 
fingers are passed along its line. 

Dislocations are not infrequently mistaken for fract- 
ures by the inexperienced, but they take place only at 
joints, and the above signs of fracture are wanting, ex- 
cepting the deformity, and possibly the shortening. A 
dislocated limb resists movements in certain directions, 
unlike the easy mobility of a broken one. 

There is a tendency for one end of a broken bone to 
slip by the other as seen to a slight extent in the figure. 
Most people think that a fracture must be set immedi- 
ately. Unless the patient is in great pain there is no 




96 HANDBOOK. 

excessive haste required. A broken bone can be ex- 
amined better, to be sure, immediately after the injury, 

because there is less swelling. 
Healing does not begin for 
a number of days after the 
fracture, even if the bone is 
put in place. 

If a surgeon can be ob- 

Fig. 16— Showing an oblique fracture . . . 

at the elbow. tamed, it is not to be ex- 

pected that any unskilled person will attempt to " set" 
a broken bone. In case an exigency should arise, the 
following hints may be of use in the treatment of fract- 
ures of the long bones, so called : those of the leg and 
arm. 

The secret of the operation of " setting a bone " is not 
difficult to understand. A proper amount of traction or 
pulling upon the limb is usually required to restore it to 
its natural shape and length, when the ends of the fract- 
ured bones generally fall into their proper place. The 
injured limb can be compared with its fellow, the sound 
one, to see if they are just alike in shape and in the 
position of the bones. The next step is to apply and 
bind on splints, to retain the bone in place. Thin pieces 
of board or strips of strong pasteboard make good 
splints. They should be long enough to reach the whole 
length of the fractured bone, padded with some soft 
material on the inside, placed on both sides of the limb, 
and firmly bound in place to prevent motion at the point 
of fracture or getting out of place. 



INJURIES. 97 

The impromptu surgeon of a certain hunting-party got 
great praise for the readiness with which he invented the 
apparatus, and set a fractured arm which one of the 
number had just received. From a birch tree near by 
he took strips of birch bark which made excellent splints, 
sufficiently firm for this part. His old linen coat was 
pressed into the service, from which first class bandages 
and paddings were made. The splints were nicely ad- 
justed and bound in place. With these improvised ap- 
pliances the fracture was " put up " on the spot in a neat 
and scientific manner, and did well till the party got out 
of the woods. 

If a surgeon can be obtained within a few hours, the 
best treatment is to place the injured limb in as easy 
position as possible, and apply flannels dipped in hot 
water to which wormwood is added, or in very cold water, 
whichever is most agreeable to the patient's feelings ; 
this prevents to some extent the pain and swelling. If 
it is necessary to move the injured person to some dis- 
tance, temporary splints should be applied, as described 
above. In compound fractures the broken skin or wound 
should be covered with a compress, wetted in some 
antiseptic solution. We describe the temporary treat- 
ment of a few of the most common fractures. 

Fracture of the Wrist is perhaps the most common 
fracture in adults. A person falling naturally throws 
out his hand to save himself, and receives the weight of 
his body upon the wrist, which gives way. The radius 
(the inner bone of the forearm) is often broken near the 



98 HANDBOOK. 

wrist joint, making what is called the silver-fork fract- 
ure. Both bones of the forearm near the wrist may be 




■Silver fork fracture of the wrist. 

broken, or the outer one only dislocated. Temporary 
splints may be applied thus : grasp the hand and elbow, 
and by gentle pulling restore the wrist to its natural 
shape as compared with the sound one. Two splints 
made of stout pasteboard and padded with some soft 
material should be applied ; one on the palm side of the 
forearm, reaching from the bend of the arm to the middle 
joints of the fingers, the other on the outer side, "with the 
hand so turned that the thumb is uppermost. Bind the 
splints on firmly with a roller bandage beginning at the 
fingers ; place the arm in a sling, bearing the whole 
length of the forearm, and raised a little higher than the 
elbow. 

Fracture of the Collar Bone is a common fracture, 
especially in children. It is easily detected because the 
bone is small, just under the skin, and can be easily felt 
and examined with the fingers. The fracture is usually 
oblique, leaving the sharp ends liable to be pushed 
through the skin, converting it into a compound fracture. 
The patient should be laid on his back with a folded 



INJURIES. 



99 



blanket between his shoulders, and no pillow under the 
head, the object of such treatment being to keep the 
shoulders outward and backward to prevent further dis- 
placement. If it is necessary to move the person, place 
a pad as large as a man's fist in the armpit, carry the 
forearm across the front of the chest and support it with 
a broad sling ; long band- 
ages should be carried sev- 
eral times around the body, 
to fix and retain the arm 
in this position. 

Broken Ribs. — It may be 
known that ribs have been 
broken if, after a fall upon 
the side, a kick or a blow 
upon it, there is a catching 
pain in the side every time 
the person takes a long 
breath, coughs, or sneezes ; 
the broken place can some- 
times be felt. 

The following simple 
treatment affords great 
comfort, and in most cases is sufficient to a cure. Take a 
stout piece of cloth, such as drilling, about one foot wide, 
and more than long enough to reach around the chest. 
Attach several buckles to one end of it ; cut the other end 
into strips to pass through the buckles ; buckle this as 
tightly around the chest as can be comfortably borne. 




Bandages applied for fracture of 
collar-bone. 



100 HANDBOOK. 

The purpose is to prevent motion of the fractured ends 
of the ribs, which is the cause of the pain. A roller 
wound tightly round the chest is good treatment. Some 
surgeons advise to put long strips of adhesive plaster on 
the injured side, extending from the middle of the chest 
bone to the back bone, and parallel to the ribs, begin- 
ning the strips at the lower part of the chest wall and 
going up. This somewhat prevents painful movement 
of the ribs. 

Fracture of the Hip. — A very common fracture, and 
one that slight causes may produce in women sixty 
years or more of age, is one at the neck of the thigh 
bone, near the joint. After such an injury movements 
of the thigh are very painful, and limited from loss of 
power. When the patient lies on the back with the leg 
extended, the foot and leg are inclined to turn outwards, 
and the injured leg is often shorter than the other. Per- 
manent lameness is usually the result. If an injury of 
this kind is suspected, the patient should recline, and the 
limb be put in as easy position as can be, with the knee 
raised and a pillow under it. 

Precautions. — A celebrated English surgeon says on 
this subject : 

" Immediately after the accident (fracture) there are 
certain minor, much neglected precautions to be taken, 
the observance of which materially affect the comfort 
and well being of the patient. Many fractures of the 
lower extremities are seriously aggravated by his own im- 
patient movements or by the ignorance and thoughtless- 
ness of attendants. Frequently is a simple converted 
into a compound fracture ; the soft parts are bruised and 



INJURIES 101 

lacerated and the foundation laid for violent inflamma- 
tions and spasms. By small care such accidents may 
readily be avoided. The patient should be placed on a 
horizontal support, whether a door or shutter, or a proper 
litter, and the foot of the injured limb should be tied to 
the other to prevent its e version by its own weight. 
Conveyance in a carriage of any kind is to be con- 
demned." 



102 



HANDBOOK. 



DISLOCATIONS. 



These are displacements of the joint ends of bones ; 
there may be, and occasionally is, a fracture at the joint 
at the same time ; but simple dislocations are common, 
The following condition of things shows that a disloca- 
tion has taken place, 

lo The joint is much deformed or misshapen as com- 
pared with the corresponding joint on the well side of 
the body. 

2. The joint cannot De naturally moved; it seems 
bound, or fixed in one direction. 

3. Absence of grating sounds when the limb is movedo 
The most common dislocations are those of the 

shoulder and elbow. A partial dislocation of the ankle 
joint is very common, and it is a 
painful and troublesome injury, 
often complicated with a fracture. 
Dislocation of the lower jaw is 
rather an awkward accident to the 
patient ; he cannot talk plainly, 
and cannot close his mouth. It 
can be put in place by nearly any- 
one with a little knowledge of what 
needs to be done. 

Treatment,— -Let the patient sit 
on the floor with his head resting against the operator's 
knee. Place between the jaw teeth a clothespin, or a 




Dislocation of the lower 
jaw. 



INJURIES. 103 

piece of wood or cork, to act as a fulcrum. The operator 
stoops down over the patient, passes the fingers of one 
hand between those of the other, forming a loop of his 
hands, and pulls upward ; the joint ends of the jaw are 
raised, and slip forward into place. 

Dislocation of Fingers and Thumbs may sometimes be 





Clove-hitch applied to dislocated finger. 

easily put in place by strong pulling, at the same time 

pressing the ends into place : but generally it requires 

more force and stronger pulling than 

one would think to reduce these small 

bones. A clove-hitch represented in 

the figure makes the best means of 

extending or pulling. 

Dislocation of the Shoulder means 

J Clove-hitch. 

the displacement of the head of the bone of the arm 
(humerus) from its socket. This is probably the most 
common dislocation which occurs in the adult. The 
shoulder appears very much misshapen, and the arm pro- 
jects from the side, and cannot without great pain be 
carried down close to the side. In some cases it easily 
slips back into place with a little manipulation, but 
generally the patient should be etherized, for this so 



104 HANDBOOK. 

relaxes the muscles that reduction is altogether easier 
and is painless. 

Treatment. — If it is certain that it is a case of simple 
dislocation at the shoulder, the following method may be 
tried. Let the patient lie down on the floor or sofa ; the 
operator places the heel of his foot (boot removed) in 
the armpit of the injured side, then pulls downward on 
the arm and sweeps it over toward the opposite side^ 
thus prying the head of the bone into its socket. 




Method of reducing dislocation of the shoulder. 

Dislocation at the elbow is apt to be complicated with 
a fracture, and should not be touched by any unskilled 
person ; and generally speaking all dislocations should 
be left for a surgeon to manage. The best thing to do 
while waiting is to place the injured part in as easy 
position as possible, and cover it with thick cloths wrung 
out of hot water, to which wormwood, arnica or laudanum 
is added, and keep the patient at rest. 



INJURIES. 105 

Bandaging. — Many kinds of bandages are used by- 
surgeons, but we shall confine ourselves to the descrip- 
tion of a few only. The roller bandage is in common 
use. It is made of any suitable material, such as old or 
new cotton cloth cut or torn into long narrow strips. 
To make it very long the strips are sewed together. 
Before it is ready for use it is rolled up into a firm roll. 
The following cut shows the appearance of the roll and 
the manner of applying it. (See Fig. 17.) 

Begin at the extremity of a limb. If a wound is at 
the ankle or a little higher on the leg, for instance, begin 
at the toes. When the bandage comes to the heel and 
ankle, a figure-of-8 turn must be made around it. As the 
bandage comes to the larger part of the leg, it must be 
folded upon itself a little, to make it lie flat and smooth. 
This is illustrated by the cut. The bandage is fastened 
with pins or stitches, or the end may be slit up into two 
strips and one carried round in the opposite direction to 
the other and tied to it. A writer suggests the follow- 
ing as proper dimensions for different parts : 

Part. "Width. Length. 

Fingers, . . . f to 1 inch, .... 1 yard. 

Arm, . . . . 2 to 2-J- inches, . . . . 3 to 6 yards. 

Leg, . . . . 1\ to 3 inches, . . . . 6 to 8 yards. 

Chest, . . . . 4 to 5 inches, . . . . 8 to 12 yards. 

Head, . . . . 2 to 1\ inches, . . . . 4 to 6 yards. 

The roller is used in applying splints to the wrist and 
forearm, and to the ankle and leg, and in dressing 
wounds of these parts. The writer has applied a roller 
bandage to-day, and since writing the above, in a case 



106 



HANDBOOK,, 



of fractured ribs. It was bound as tightly around the 
chest as the man could bear, thus preventing painful 
motion of the broken ribs, and affording great relief. 




Fig. 17. — Applying the Roller Bandage. 

The triangular, called also the Esmarch, and the hand- 
kerchief bandage is better adapted to use in many cases. 
It may be made from a piece of cloth forty inches square, 
cut through from one corner to the opposite one. A 
large square handkerchief folded into triangular form 
makes the same thing. A society in N. Y. City for 
instruction in first aids to the injured, directs that 
instruction shall be given in the use of this bandage 




Figure-of-8 and4-Tailed Bandage applied to the Head. 

only. It can be folded into a narrow or a wide bandage. 
The accompanying diagram shows the various ways the 
triangular bandage may be used. 



INJURIES. 107 

The Jlgure-of-8 bandage is sometimes needed. It is 
made of long narrow strips of cloth and used in dressing 
fractures of the collar bone, in sores or wounds in or 
about the armpit, etc. (See page 99.) 

The 4-tailed bandage is made by taking a piece of 
cloth about six inches wide and as long as desired, and 
splitting up both ends to within four or six inches of the 
center. It is used in dressing wounds of the knee joint, 
fractures or wounds of the lower jaw, and in applying 
dressings to the head. 

To fasten temporary splints to the limbs, the handker- 
chief bandage or any piece of cloth of uniform width, Or 
even cords may be used. In applying bandages to limbs, 
it must be remembered not to put them on more tightly 
above than at the lower part of the limb. It might pro- 
duce troublesome and painful swelling. 

Sprains of Joints. — Joints are fastened together 
by ligaments. When the joint is violent!} 7 twisted, 
these bands or ligaments are overstretched or strained 
and often torn, causing a great amount of pain, swelling 
and discomfort. Ligaments are not elastic, and can- 
not be stretched without injury. The pain in many 
cases of sprains is as severe as it is in fractures. A 
sprain may be known by the fact that the joint re- 
mains in its natural shape, except the swelling, as com- 
pared with its fellow ; if fractured or dislocated, it is 
misshapen very evidently. Sprains of the ankle are 
common and are troublesome and painful things. Tke 



108 HANDBOOK. 

end of one of the long bones which passes down to the 
joint is often fractured in addition to the sprain. In 
case of severe sprain of the ankle the best treatment at 
first is to put the foot into a pail full of hot water, fre- 
quently adding to it more water to keep it hot ; con- 
tinue this for an hour, then remove it from the water, 
rub dry and apply a roller bandage tightly, beginning at 
the toes and putting it on half way up the leg. This 
treatment prevents inflammation and swelling, and 
relieves pain. The next important thing is to keep the 
ankle at perfect rest. No attempt should be made to 
step upon the foot for awhile. All other sprains may 
be treated on the same principle. Some physicians 
direct that the sprained joint should be treated with the 
application of cloths wrung out of ice-cold water to pre- 
vent inflammation. Whatever is applied, rest of the joint 
is very essential to a speedy cure. Liniments at first 
are of but little use. 



INJCKIES. 109 



BURNS AND SCALDS. 

These are too common to call for much description. 
They are always painful and need prompt treatment. 
The danger to life is considerable in many cases. It is 
said that if one-third to one-half of the skin is burned 
or scalded the injury will prove fatal within twenty-four 
to forty-eight hours in a large number of the cases ; but 
a strong and robust person, with a good nervous system, 
sometimes recovers when one-half or more of the skin is 
burned. Deep burns require a very long time to heal ; 
healing takes place by granulation. 

Treatment. — For the small burns and scalds which 
housewives and others are constantly getting, there 
is one remedy of very great convenience and value. It 
should be kept in everybody's kitchen — a mixture of 
equal parts of creasote and glycerine to be smeared upon 
the burn as soon as it is received, and repeated every 
few minutes till the smarting is cured. 

Another remedy, and one that is generally at hand, is 
common cooking soda. Moisten a little with water — 
making a paste, and apply directly, or dissolve all the 
soda that can be in a cup of water ; wring out cloths in 
the solution and apply repeatedly. A mixture of linseed 
oil and lime water, called carron oil, is an old remedy 
and a good one. Anything which excludes the air and is 
soothing to the fine, irritated nerves of the skin is bene- 



110 HANDBOOK. 

ficial, such as oil, vaseline, molasses, lard, the white of 
eggs, cream, starch, flour, etc. 

But for large and deep burns or scalds the treatment 
must be somewhat different. When the hands and feet 
or arms and legs are extensively burned, it is best to 
plunge them into cold water till something better can 
be obtained ; or cloths dipped in cold water in which 
much soda has been dissolved may be used. 

If it is at hand, a solution of carbolic acid may be 
applied. It has a soothing and benumbing effect upon 
the sensitive nerves of the injured skin. 

Linseed oil and white lead (white paint) freely poured 
over the burned or scalded part is excellent treatment ; 
it excludes the air and relieves the pain instantly. 

An ointment made of one part subnitrate of bismuth 
to two parts of cosmoline makes an elegant and effective 
remedy when spread on thickly and covered with a soft 
cloth. Some surgeons advise to pour on mucilage and 
dust flour over it to a thick coating. 

After a burn or scald begins to heal, cosmoline or 
vaseline to which a little carbolic acid has been added 
makes an elegant and first rate dressing. It should be 
applied on a little lint or soft cloth. If this cannot 
be obtained, some simple ointment, or even mutton tallow 
or fresh lard, may be substituted ; the object being to 
exclude the air and prevent irritation of the healing sur- 
face. The skin is sometimes burned with sulphuric, 
nitric, muriatic or other acids. Water should not be 
applied in these cases ; it increases the injury. The 



INJURIES. Ill 

proper treatment is to dust on chalk or magnesia. 
Burns with caustic alkalies such as soda, potassa, lye 
and ammonia should be immediately drenched with vine- 
gar. When large blisters are formed, care must be taken 
not to rupture them ; they should be pricked under the 
skin. In cases of extensive burns, the clothing must not 
be pulled off rudely, for fear of injuring the skin or of 
breaking the blisters. The nervous system is sometimes 
profoundly disturbed by burns and scalds. Coma, con- 
vulsions and delirium may occur. Bronchitis, laryngitis 
or pneumonia sometimes result from burns of the neck 
and chest, and ulceration of the bowels from burns of 
the abdomen. If the shock to the nervous system seems 
severe, stimulants may be needed, and an anodyne is 
required to relieve intense pain. 

Precautions. — A person whose clothing has caught on 
fire, instead of running wildly round should lie down 
and roll himself up in a woolen rug, piece of carpeting, 
shawl or blanket, or anything at hand, in order to smother 
the fire. The majority of cases of injury from fire result 
from the explosion or dropping of lighted kerosene lamps, 
and from pouring the oil upon lighted fires. Good oil 
flashes only when heated to 150° or 160° F. ; if it was 
always used, many of these accidents would be avoided. 
Cheap oil easily explodes and is dangerous. Water 
should not be thrown upon burning oil on the floor ; it is 
liable to scatter the fire over the room. The vapor from 
the following is explosive, and a light should never be 
brought near an open vessel containing them : gasoline, 



112 HANDBOOK. 

benzine, naphtha, ether, campliire, turpentine and alco- 
hoi. To extinguish small fires in the house, bottles con- 
taining the following liquid may be kept in rooms for 
immediate use. Dissolve ten pounds of common salt 
and five pounds of sal ammoniac in three and one-half 
gallons of water ; fill the bottles, and cork. When a fire 
occurs, throw one or two bottles into it with force enough 
to break them. The laws of many states provide that 
fire-escapes shall be placed on all high buildings in which 
workmen are employed. As a precaution for their own 
safety, workmen should insist upon it that such provision 
for escape in case of fire should be supplied in all cases. 

Suspended Animation is a term often usacl by 
doctors, and means that a person in this state is in a con- 
dition of apparent but not real death, that to appear- 
ances he is lifeless ; he is profoundly unconscious ; there 
is no pulse at the wrist, and apparently no breathing ; 
the appearance of the face is like that of the dead. In 
certain cases of this kind life may be restored by appro- 
priate treatment. The apparently drowned, persons 
suffering from breathing burning gas, charcoal fumes, 
carbonic acid gas, etc., a person struck by lightning, 
and the inexplicable conditions of trance, etc., are exam- 
ples of Suspended Animation. In the following articles 
the means of resuscitating persons from this seeming 
death will be described. A Boston physician has pul> 
lished a medical work devoting nearly one-third of its 
pages to a consideration of this subject. He claims 



INJURIES. 113 

that many persons are buried while in a condition of 
suspended animation, who could have been, with proper 
means, resuscitated. 

Artificial Respiration. — This is an operation of 
the greatest importance as a means of saving life in some 
cases of suspended animation. One who would render 
intelligent assistance in such cases should understand 
how to perform it ; it is not difficult in itself, nor hard 
to understand. What is it ? It is simply a method of 
keeping up the respiratory movements of the chest when 
the natural breathing is about to stop. Dr. Thomas, in 
his medical dictionary, defines it thus : 

M An important means towards the resuscitation of the 
apparently drowned or those asphyxiated from breathing 
poisonous gases or of those suffering from a powerful 
dose of some narcotic poison. One method is placing 
the body on one side and alternately rolling it on its 
face to compress the chest and on its back to allow the 
elasticity of the ribs free movement to draw air into the 
lungs. Another mode termed 'Silvester's Method* is 
to place the patient on his back and then raise the arms 
upward above his head pulling firmly and steadily so 
long as there is any sound of air entering the chest. As 
soon as this sound ceases the arms should be brought 
down against the chest and pressed against it firmly and 
steadily for a second or two after air is heard escaping. 
This operation should be repeated every three or four 
seconds." 

Before trying the above-described method, try this : 
place one hand on the patient's chest, the other on his 
abdomen, and make firm pressure for one or two 
seconds ; then remove the hands for as long a time, 



114 



HANDBOOK. 



repeating the movement. If the sounds of air passing 
into and out of the lungs are heard, this method may be 
continued for a minute, when possibly natural breathing 
may begin. If this is not successful, Silvester's Method 




should be tried immediately. The first movement is to 
draw the arms above the head while counting one, two, 
three. This movement expands the chest and allows air 
to enter the lungs. It is illustrated by the above figure. 




The second movement is to carry the arms to the sides, 
with the forearms resting on the chest, and with these to 
make firm pressure while counting one, two, three. 

One other thing must be remembered. It may happen 



INJURIES. 115 

in a person almost lifeless, that the tongue falls back- 
ward into the throat, preventing air from getting into 
the lungs. An assistant with a dry handkerchief in his 
hand must seize the tongue and keep it drawn forward 
while the operations continue. These movements should 
be continued, not simply for a few minutes, but for an 
hour or more, if need be, when the impromptu surgeon 
may be rewarded by the delightful evidences of return- 
ing life. Artificial respiration has saved many lives 
which could not have been otherwise saved. It is here 
described, for it should be understood before studying 
the treatment of drowning or asphyxia (obstructed 
breathing) from other causes* 



116 HANDBOOK 

DROWNING. 

RESUSCITATION OF THE APPARENTLY DROWNED. 

If a person is submerged in water, one of two things 
happens :■* 

First. If he struggles, opens his mouth and breathes 
water into the lungs and fills them with it, life can con- 
tinue only about one minute, and the chances of resus- 
citation are next to nothing. 

Second. A condition resembling fainting sometimes 
happens. The heart beats Only feebly ; the breathing is 
so nearly stopped that no water is drawn into the lungs ; 
again, if the person holds his breath till the head comes 
above water, and then takes a deep breath, he may live 
a longer time. " Marac relates the case of a German 
woman who was tied up in a bag with a cock and a cat, 
and thrown into the water as a punishment for child- 
murder. She was submerged fifteen minutes, and, when 
removed from the bag and exposed to the air, immedi- 
ately recovered. Such a prolongation of life without 
air can only be accounted for on the supposition that 
the woman fainted on being immersed, and that the 
state of syncope lasted until she was brought to the sur- 
face." Human beings when drowning alternately sink 
below and rise again to the surface, giving them a 
chance to breathe if the lungs are not filled with water ; 

*It is stated by some surgeons that a small percentage of deaths are the re- 
sult of Shock, Apoplexy, Concussion of the Brain, etc. It would be difficult 
to decide at once in a given case whether either of these had happened. 



INJURIES. 117 

on this account the time a person may remain in water 
and yet live, varies. The writer knows no way of decid- 
ing positively which of the two things above described 
has happened to the person who has been taken from 
the water apparently drowned ; in one case there is a 
chance of resuscitation, therefore in all cases a persist- 
ent attempt should be made to restore to life. 

Treatment. — The patient urgently needs two things : 
first, that air should be supplied to the lungs — and this 
must be done artificially if breathing has stopped ; 
second, warmth oo the skin is needed. This is a key to 
the treatment. Before beginning artificial respiration, 
which is the most important means of getting air into 
the lungs in imitation of the natural act of breathing, an 
effort must be made to get all the water possible out of 
the body. To do this, the patient's tongue should be 
drawn forward first so that the tip of it rests upon the 
chin, and kept there by an assistant. The chin should 
be carried forward from the chest in order to stretch 
out the neck. With the patient's body face downward, 
the operator stands astride it, and with his hands spread 
out under the stomach raises the body partly from the 
ground, and holds it in this position for a few seconds, 
to allow water to run out from the stomach, air passages 
and lungs, repeating the act a few times. The body 
should now be turned upon the back and artificial respi- 
ration begun at once, after clearing the mouth and throat 
Of all foreign substances by sweeping them out with the 



118 HANDBOOK, 

fingers. This operation is fully described in the preced- 
ing article, which see. 

If the operation is properly performed, air may be 
felt coming from the mouth and nose at each compression 
of the chest. If natural breathing begins, it should be 
aided by holding ammonia to the nose, and by dashing 
hot and then cold water upon the chest ; this makes a 
person catch his breath, as the common saying is. Stim- 
ulants should be given as soon as the patient can swal- 
low. In the mean time, and while efforts are being 
made to get air into the lungs, warmth or heat must be 
applied to the body in any convenient way, with bottles 
of hot water, hot plates or bricks, hot blankets, etc., as 
soon as the wet clothing is removed. Rubbing the skin 
with dry and hot blankets is useful. The rubbing should 
be upward towards the heart. 

An old-fashioned way of reviving the drowned was to 
roll the body on a barrel. The water might be gotten 
out in this Avay, but the required compression and expan- 
sion of the lungs are better made with the newer 
methods. 

It has been reported that a man has been restored, 
after all other methods failed, by applying to the chest 
plates of hot iron. 

Precautions.— If one falls into the water and there is 
danger of drowning, it is of great importance to remem- 
ber (provided that one can retain self-control) to try 
and float upon it till assistance arrives, if he cannot 
swim. The body is lighter than water, and will float if 



INJURIES. 119 

the arms, legs, and the back part of the head are kept 
under water, and if not much water is swallowed. He 
should try to lie on his back, stretched at full length, 
with his arms and legs kept quietly under water, and 
his head thrown back on a level with the body. Care 
must be taken to keep the mouth closed, and to inspire 
quickly and fill the lungs full of air, and hold the 
breath as long as possible. Struggling and throwing 
the arms out of the water is a dangerous thing to do, 
and if one does not guard against it he will sink. Pas- 
senger vessels and pleasure yachts are, or should be, fur- 
nished with life-preservers which greatly help to float 
the body. If one is obliged to jump into the water or 
take to a life-boat, he should think to fasten one of these 
to the body. Beware of small sail boats. They are 
dangerous things on inland lakes or on the ocean. A 
sudden gust easily overturns them. A great many lives 
are lost every year from accidents of this kind 



120 HANDBOOK. 

INJURIES FROM LIGHTNING STROKE. 

MEANS OF AVOIDING DANGER 

During severe thunder-storms many persons are very 
timid and suffer from nervous disturbances such as head- 
ache, partial blindness, vomiting, swooning, and hyster- 
ical attacks. This may seem foolish to those who look 
upon these storms calmly, as Nature's delightful pyro- 
technic displays. Some real protection against danger 
may be provided, so that the timid may feel, as much as 
possible, that their chances of harm have been reduced 
to a minimum. Precautions will be described below- 
There are, of course, various degrees of injury from 
lightning, from the most harmless shock to an injury 
resulting in instant death ; but it may be said here that 
only a small number of those who are "struck" are 
killed. In cases of slight injury the person is more or 
less dazed, and perhaps loses consciousness for a brief 
time ; there is sometimes a feeling as if he kad received 
a blow, or been blinded with a dazzling light ; or there 
may be a sensation of numbness, or a partial paralysis 
of the limbs, which generally passes off in a few hours 
or days. Nausea and vomiting often occur. In severe 
cases of stroke the person is knocked down, and may 
remain unconscious for an indefinite length of time ; still, 
with proper treatment, he will recover. It is the small 
side current which gives the slight shock, or stroke, 
from which a person may, and often does, recover. If 



INJURIES. 121 

one is struck by the main electrical current, there is no 
question but that it produces instant and painless death 
in most cases. 

Treatment. — If, after a lightning stroke, a person does 
not seem to breathe, he must be immediately examined 
to find whether there is any, even the slightest beating 
of the heart, or pulsating of the large arteries of the 
neck, or if there is the faintest effort at breathing, or 
motion of the chest ; for in many cases death may be 
only apparent, not real. If there is the smallest possi- 
bility that a spark of life remains, instant efforts at 
revival should be made. Strip the patient's chest by 
cutting off the clothing, and dash cold water upon him. 
If this does not revive him, resort to artificial respira- 
tion, as in cases of drowning. This affords the best 
means of restoring the patient to life. The operation 
should be continued for a long time if the slightest evi- 
dences of life are noticed. When the skin is cold and 
bathed in sweat, when the pulse is small and rapid, the 
person is suffering from nervous prostration and failure 
of the circulation, and needs artificial heat applied 
around the body, and a vigorous rubbing given to the 
skin with heated blankets. Stimulants are needed, such 
as the aromatic spirits of ammonia, alcoholic spirits, or 
strong tea or coffee. 

Precautions. — A person is safe during a thunder- 
storm in a hammock suspended by silken or rubber 
cords, attached to porcelain knobs ; the hammock to be 
stretched across the room, and raised about three feet 



122 HANDBOOK. 

from the floor. Even if the house is struck by light- 
ning, there would not be one chance of injury in man}? 
thousands! A bed, in the season of thunder-storms, 
may be made a place of more safety by pulling it away 
from partitions, discarding wire springs and using hair, 
husk, or feather mattresses. The posts may be rested 
upon insulators made of thick glass sauce dishes, or the 
thick bottoms of tumblers. The doors and windows of 
the room should be closed to prevent draughts of air. 
There is no doubt but that lightning-rods lessen the 
danger from lightning when they are well insulated, and 
when the rods are run deeply into the damp ground, to 
conduct off the fluid ; if in poor repair, they increase the 
danger. Steam-pipes running through the house are 
good conductors of electricity ; on this account a wire 
or rod should be attached to them and run into the damp 
ground, as it will conduct the fluid safely away. The 
middle of the room and the first story of the house are 
the safest places. The fluid is apt to run down chim- 
neys, smoke stacks, and the sides of the house if it is 
wet. A very unsafe place is that between the kitchen 
stove and the iron sink, for the lightning is apt to come 
down the chimney and jump to the sink. Avoid stand- 
ing under trees, in open sheds, or in barns in which 
newly mown hay is stored. 

Foreign Bodies in the Air Passages. — It some- 
times happens that small things such as peanuts, grains 
of corn, beans, seeds of fruit, pebbles, buttons, bits of 



INJURIES. 123 

food, etc., are drawn from the mouth into the throat or 
air passages by the act of coughing or laughing. Spas- 
modic coughing and great distress instantly follow. If 
the body is large, there is imminent danger of suffoca- 
tion. The patient gasps for breath, the face becomes 
purple, the eyes protrude, he cannot breathe, and may 
lose consciousness. If the bod}' is small, in fortunate 
cases and quite often it is thrown out by the act of 
coughing. In a case which the writer attended a piece 
of peanut was drawn into the bronchial tube. Cough- 
ing was severe at times for twenty-four hours, but was 
followed by convalescense and recovery. It is said that 
in some cases the symptoms are not very severe — 
depending perhaps upon what the particular part is in 
which the body lodges. 

Treatment. — Send for a surgeon and inform him what 
has happened so he may bring proper instruments. It 
is always possible that the foreign body may be lodged 
in the back part of the throat, obstructing the entrance 
of air into the windpipe. If the patient is a child, invert 
the body at once so that the head and chest will hang 
downwards ; then strike the back violently several times 
for the purpose of driving the breath forcibly out of the 
lungs and with it the foreign bod} T ; if this does not do 
it, open the child's mouth and thrust the fingers into his 
throat and try to find anything that may be there, and 
remove it by hooking it out with the fingers. This 
causes vomiting usually which helps to dislodge the 
bouy. Some surgeons advise to give snuff or tickle the 



124 HANDBOOK, 

nostrils with a feather to produce sneezing to expel ias 
body. In the worst cases surgeons perform laryngot- 
omy (opening the windpipe) to save life. 

Strangulation. — This term is applied to mechanical 
compression of the windpipe sufficient to stop the breath. 
Garroting, attempts at hanging with suicidal intent are 
examples of strangulation. Death results from Asphyxia 
or an insufficient supply of air to the lungs. If the 
chest walls are compressed by a falling embankment, or 
by timbers or other things, the result is the same. 

The notorious grave robber and murderer, Burke, 
usually destroyed his victims by compressing the chest, 
thus preventing breathing. When the person is removed 
or rescued from these dangers before death really takes 
place, artificial respiration, as described in the preceding 
article, should be at once performed, as it offers the best 
means of saving life in this form of suspended anima- 
tion. 

Injuries from the Inhalation of Gases. — If 

the patient does not die immediately from these acci- 
dents, he remains in a condition of suspended animation 
or apparent death for a longer or shorter time, and pos- 
sibly may be revived by proper treatment. These 
gases are usually considered poisonous, but when a fatal 
result is reached it is owing partly to poisoning and 
partly to true asphyxia or air hunger, and must be 
treated accordingly. 



INJURIES. 125 

Sulphuretted Hydrogen is the product of decomposing 
animal matter. The foul odor of rotten eggs is owing 
to this gas. It is often generated in sewers and old 
drains. If large quantities are inhaled, insensibility re- 
sults. 

Carbonic Acid, or the di-oxide of carbon, is found in 
the bottom of wells, coal mines and in low damp places 
where organic matter is decomposing. In coal mines it 
is called choke-damp. Atmosphere containing one-tenth 
part Carbonic Acid, if breathed, will produce fatal re- 
salts. 

Cliarcoal-vapor is made up of carbonic acid, carburet- 
ted hydrogen, free nitrogen, etc., and the inhalation of 
it is dangerous. At first great languor is felt; afterward 
the patient falls into a fatal stupor unless he is rescued 
and immediately exposed to fresh air, and made to 
breathe artificially if natural respiration has stopped. 

Smoke. A room maj^ be filled with dense smoke 
when the house is on fire. Smoke contains suffocating 
and poisonous gases sufficient to stupefy a person re- 
maining in a room filled with it. 

Coed-vapor .from ordinary burning anthracite and 
bituminous coal is sometimes inhaled in sufficient 
amounts to produce insensibility and death, unless 
prompt treatment is at once begun. 

Coed-gas or illuminating gas. If the atmosphere of a 
room contains twelve per cent, of this gas, an explosion 
will happen if a lighted candle is brought into the room. 
Ignorance or neglect to turn off the gas, or leakage in 



126 HANDBOOK. 

the pipe, are frequent causes of accidents. The inhala- 
tion of this gas produces effects different from the gases 
above named. Nausea, vomiting and dizziness, fol- 
lowed by convulsions, are the common symptoms. 

Treatment. — Suffocation caused by breathing either of 
the above gases is rapidly cured by exposing the patient 
to fresh air, provided he has not been too long stupefied. 
It is recommended to dash cold water upon the exposed 
chest at once. If breathing seems to have stopped, 
artificial respiration, fully described on page 113, is 
about the only menus of restoring the patient to life ; he 
is suffering from air hunger as well as from poisoning. 



INJURIES. 127 



HAS DEATH ACTUALLY TAKEN PLACE? 

SIGNS OF DEATH. 

" God's club makes no noise, but when it strikes there is 
no cure for the blow." — Russian Proverb. 

"By medicine life may be prolonged, yet death will seize 
the doctor too." — Cymbeline. 

"Death is a black camel that kneels once at every man's 
gate." — Arab Proverb. 

The fear of the possibility of being buried alive, which 
troubles the minds of many people, has urged medical 
and scientific men to discover some unfailing tests or signs 
of death. In some cases death may be so closely coun- 
terfeited that it is not easy to decide at once, and with 
certainty, that the body supposed to be dead is actually 
dead. Nothing more dreadful could be thought of than 
the mistake of burying a person alive. As it is some- 
times necessary to decide in the absence of a medical 
man whether a person is really dead or not, we shall 
give below the most reliable tests and signs of death, 
and those that any intelligent person can apply. It is 
only in cases of suspended animation that reasonable 
doubts arise, for when the case is one of ordinary sick- 
ness, gradual failing and apparent death, there is not 
one chance in a million of revival after a brief time. 

The startling stories we hear and read about persons 
being buried alive are without foundation in fact ; they 
are kept alive by superstitious fear, and the great credu- 
lity of ignorance. 



128 HANDBOOK. 

Dr. Dulles, of Philadelphia, says on the subject of this 

fear : 

" The stories upon which it rests are such as an excited 
imagination might easily invent, and natural fear propa- 
gate, but they do uot bear critical investigation. In 
certain European cities, for many years, the bodies of 
hundreds of thousands of those supposed to be dead 
have been placed in rooms where ingenious appliances 
and careful watchings have been used to detect the 
slightest evidence of life, and not in a single case has a 
mistake been found to have been made." 

If the heart has stopped beating, or if the breathing 
has actually stopped for one minute, or possibty a little 
more, the person is really dead ; but the pulsations of 
the heart and the respiratory act may be so feeble, that 
by an inattentive person they would not be observed. 
The following tests and signs are believed to be the 
best and principal ones known up to the present time. 

Let a thread or cord be wound tightly around the finger 
a little distance from the end. If there is life and con- 
sequentty circulation of the blood, the end of the finger 
will after a while become a little swollen and purple in 
color compared with the other parts of it. 

Listen over the region of the heart for the least sound 
of beating ; after listening attentively for some time and 
not hearing a sound, it is presumptive evidence that there 
is no life ; but one might be mistaken about this. 

If your own hand or the hand of a living person be 
held before a bright light, with the fingers pressed to- 
gether, a beautiful pink color will appear between the 
fingers ; the blood is circulating in the skin ; in the hand 



INJURIES. 129 

of a body not living, no such color can be seen — nothing 
but a dead- white. 

To test for breathing, hold a flake of cotton-wool or a 
feather-down before the mouth ; even slight breathing 
imparts a wavy motion to it. A dry mirror may be held 
over the face ; if no moisture collects upon it, it may be 
inferred that life has departed, for if there is feeble 
breathing, moisture collects from the exhaled air. 

Another test is to place a plate or other vessel filled 
with water upon the chest. If there is the slightest 
movement in breathing, there will be a change in the 
reflection and surface of the water. 

If, in a living body, the flame of a candle, or piece of 
iron brought to red heat be held near the skin for a short 
time, a water-blister or vesication will be raised. In the 
dead body the skin will only be shrivelled and black- 
ened. In real death the thumb is drawn in upon the 
palm of the hand, and the fingers flexed upon it, while 
in seeming death the thumb remains free and extended. 

A reliable test can be made by means of the galvanic 
battery, which, of course, would be convenient only for 
undertakers and physicians. Contractions and spas- 
modic action of the limbs will take place w r hen the bat- 
tery is applied to them within three or four hours follow- 
ing actual death ; after that time no such action can be 
produced, everything will be as " still as death." There- 
fore, when the battery applied six or eight hours after 
supposed death produces contraction of the limbs, fur- 
ther investigation should be made, for there is presump- 



ISO HANDBOOK. 

tive evidence of life. All the above tests can be applied 
within a few hours after supposed death. 

In case of real death, after twenty-four hours, or less, 
certain changes in the body take place, which, when 
present, may be regarded as positive proofs of death. 
One of these changes is what is called in medical lan- 
guage rigor mortis, which means that the limbs, the 
neck, aud other parts of the body are rigid and im- 
movable, unless considerable force is used. This usually 
takes place in from ten to twenty-four hours after death. 
It should be remembered that this rigidity does not 
always last a long time ; a body in which rigor mortis 
had been previously well marked, might not be rigid 
thirty-six hours after death. In cases of drowning the 
rigidity should not prevent attempts at resuscitation. If 
the body be kept a sufficient length of time, infallible 
signs appear, namely, the beginning of decomposition, 
which may be first seen over the abdomen, as a green 
discoloration of the skin beginning about the third day. 
If no such discoloration or signs of decomposition can 
be found as late as the third day after supposed death, 
it would be presumptive evidence that life is only sus- 
pended — that death had not really taken place ; further 
time would be required to make sure. 

Injuries from Severe Cold. — The first effect of 
continued exposure to extreme cold is a sense of pain. 
If the exposure continues for a long time, a feeling of 
numbness creeps over the body, the person no longer 



INJURIES. 131 

suffering pain ; if walking, he may stagger in his gait ;. 
he cannot speak distinctly and perhaps he is wandering in 
his mind ; a strong inclination to sleep now steals over 
him which he cannot resist, and to sleep is to die. Sev- 
eral things increase greatly the dangers of exposure to 
severe cold. Among these are hunger, fatigue and men- 
tal depression ; but more than these a drunken state 
renders the person extremely liable to die from the 
effects of cold. It is said that "after a public fete in 
St. Petersburg, during which an unlimited supply of 
spirituous drink was placed at their disposal, 1,800 per- 
sons perished from cold in the streets and squares of 
that city." In that celebrated retreat of the French 
Army under Bonaparte from Russia after the burning of 
Moscow is the most remarkable instance in history of 
death and suffering from intense cold. Many thousand 
men, half starved, fatigued and disheartened perished 
from cold and frost-bites. Yet it is a fact that a well- 
fed person, in good health and spirits is able to bear 
exposure to intense cold without harm under certain 
precautions. Dr. Kane and his men during his Arctic 
voyage lived, and a part of the time out of doors, when 
the temperature was from 50° to 70° below zero. Chill- 
ing of the body may take place so insidiously that one 
may scarcely be aware of it, especially if he is in poor 
health or exhausted. Still cold is much less dangerous 
than when accompanied with wind which rapidly 
increases the evaporation from the surface of the body. 
Frost-bites and Freezing of Limbs are the most com- 



132 HANDBOOK. 

mon injuries from exposure to cold. Feet, toes, heels, 
fingers, the nose, ears and cheeks are often frozen. 
There is always the warning sign of danger — a stinging 
pain in the part about to be frozen. Before the part is 
frozen it becomes pale, bloodless and without sensibil- 
ity, and if the first sensation of pain is not heeded, the 
toes or the feet may be frozen before the person is 
aware of it. 

Treatment. — When a person has been overcome with 
cold, is insensible and nearly frozen to death, he 
should not be brought immediately into a hot room, but 
into a moderately warm one. The skin should at first 
be vigorously rubbed with cloths dipped in spirits, or in 
vinegar, followed by friction with hot dry flannels till 
reaction takes place. As soon as the patient can swal- 
low, stimulants such as strong coffee or the aromatic 
spirits of ammonia or alcoholic spirits should be given. 
If the person does not breathe when first found, artificial 
respiration may be required. Frozen or frost-bitten 
feet, hands, fingers or toes should be immediately 
plunged iuto cold water for awhile, then genfcly rubbed 
with soft flannels ; for such parts as the ears or nose 
cloths wet in cold water may be applied, or rubbing the 
part in snow is good treatment. If the frost-bite after- 
ward seems swollen and tender, the frequent application 
of the spirits of camphor, or a solution of the sugar of 
lead is of great benefit. Some surgeons recommend 
poulticing. 

Chilblains are common in children. One of the best 



INJURIES. 133 

things to do is to paint the part twice a day with weak 
tincture of iodine. Plunging the feet into water as hot 
as can be borne affords relief, but it should be followed 
by wrapping the feet in cloths wet with laudanum or 
with a solution of the sugar of lead. Wrapping the 
parts in cloths saturated with the essence of peppermint 
often affords great relief. 

Precautions. — If a person is obliged to expose him- 
self to severe cold, he should eat plentifully of fat meats, 
butter or cheese and other nourishing food. It is unsafe 
on scientific grounds to drink freely of alcoholic spirits 
before continued exposure to cold ; the final effect is to 
lower animal heat and to lessen greatly the power of 
resistance. Beware of riding across prairies or large 
lakes in very cold days or nights ; it is a dangerous 
thing to do ; one gets chilled before he knows it. 

Things in the Eye. — It is a very common accident 
to get small objects into the eye. It is bad practice to 
rub the eye because it feels badly ; cover it with a hand- 
kerchief, or if at hand with a cloth saturated with hot 
water. There is always a copious flow of tears, which 
often floats the foreign body out upon one of the lids, 
when it can be wiped off. If it lodges, it is apt to be 
under the upper eyelid. 

Treatment. — Take, with the thumb and fingers, the 
upper lid, pull it away from the eyeball and stretch it 
down over the lower lid, allowing it to draw back so 
that the eye-lashes of the lower lid may brush off the 



134 HANDBOOK. 

object from the inner side of the upper lid. The opera- 
tion can be repeated if required. If this does not do it, 
the upper lid must be turned back in *his way : Take a 
small pencil and press in between the eyeball and 
v / ^ss? i$ socket, then with the thumb 

7 M and fingers turn the upper 

vu / 3mm lid inside out. If anything 

v^g^^^llpjfe is lodged on the lid, it can 

m - ^SnK 0^^^^^> ■ De seeD anc ^ wiped off. If a 
i^fflr'' /^^^^v ^lK— piece of steel, glass, or any- 
~Sg||!MH pi^^c thing else is embedded in the 

"^^ Sgiy"' ^ eyeball this will not remove 

it ; the patient should visit a surgeon. 

Pieces of lime or other kinds of alkali sometimes get 
into the eye ; if so, pour vinegar diluted with water into 
the eye to neutralize the alkali. If acids get into the 
eye, wash it in soda-water, or in lime-water. A magni- 
fying glass is of great assistance in looking for small 
objects in the eye, or on the lids. It frequently hap- 
pens that a patient thinks, after something has been in 
the eye, that it is not all out when it is. A little rough- 
ness (a slight wound) remains, which gives nearly the 
same sensation that a foreign body does. 

Very much irritation and pain are apt to remain in the 
eye after the foreign body has been removed. This 
calls for applications of cold water or cold tea. An ex- 
cellent remedy to allay the irritation is prepared in this 
way : heat a cup and turn into it a little laudanum. The 
alcohol is evaporated and a jellylike mass is left. Add 



INJURIES. 135 

to this a little water to make it thin, and pour a little 
into the eye every hour ; or a thin mucilage made from 
pure and clean gum-arabic may be poured into the eye. 
A troublesome irritation of the eye is sometimes 
caused by a hair turned inward from the eyelid. It 
must be pulled out with a pair of forceps or tweezers — 
not broken off, for the irritation would be increased. 

Things in the Ear. — The length of the ear canal 
is about one inch and a quarter, and at its inner ex- 
tremity is a delicate membrane, the tympanum, or drum 
of the ear. If foreign bodies get into the ear, and are 
allowed to remain, they may produce serious inflamma- 
tion, destroy the drum, and cause deafness. Insects, 
fleas, and bugs in the ear are very annoying, but they 
can be removed easily. Grains of wheat, seeds, gravel 
stones, etc., are more difficult to remove. If allowed to 
remain two or three days, there is a discharge from the 
canal which soon becomes bloody and purulent. Rough 
efforts to get them out might rupture the delicate tym- 
panum, and cause permanent deafness. 

Treatment. — A surgeon recommends, to remove 
insects, to stuff into the ear " a piece of cotton-wool, 
thoroughly saturated with a strong solution of salt or 
vinegar, and large enough to fill the orifice. After its 
introduction, turn the patient on the affected side, and 
allow the hand to press firmly on the ear. In a few 
minutes the noise and irritation will cease, and, if the 



136 HANDBOOK. 

plug at this time is withdrawn, the insect will probably 
be found partially embedded in its substance." 

Another method is to fill the ear with oil, and thus 
float the insect out. Larger bodies may sometimes be 
removed by syringing the ear while the head is held 
down — the operation should be done gently. A fine 
wire bent into a loop is a good instrument to remove 
anything from the ear. Generally, the patient should be 
taken to a surgeon. 

Things in the Nose. — Children often get small 
bodies into the nose, such as buttons, peas, beans, etc. 
There are several ways of removing these things. 

Treatment. — The nostrils may be tickled with a 
feather, or snuff may be given to produce sneezing. 
When the child is about to sneeze, press one nostril 
tightly together, to allow air to be forced through the 
other in order to expel the intruder. If beans or peas 
remain for twenty-four hours they swell, and cannot be 
removed without the use of forceps or tweezers. A 
small wire bent up into a loop will sometimes be of good 
service in removing small things. 

Things in the Throat. Choking.— This is 
usually caused by attempts to swallow large pieces of 
food which stick in the throat. The person has a feel- 
ing as of strangling, he cannot breathe well, and if the 
body is not soon thrown out he becomes black in the 
face. A tipsy Irishman, eating at a table with others, 



INJURIES. 137 

in trying to swallow a large piece of meat was strangled 
and in imminent danger. A stranger at the table see- 
ing the emergency, without waiting for an introduction, 
struck the sufferer a powerful blow on the back, which 
knocked the breath out of him and the meat, too. The 
Irishman was too tipsy to appreciate such impromptu, 
though scientific treatment, and threatened his skilful 
benefactor with severe punishment. Some surgeons ad- 
vise to stand a choked person facing a wall, his chest 
resting against it, and strike him a powerful blow on 
the back. The patient himself should thrust his fingers 
down his throat, and pick out, or hook out, the foreign 
body. If he cannot do it himself, a bystander should 
immediately undertake it. No risk or danger attends 
such an operation, and the offending body can generally 
be removed in this way. Another method is to hook 
out the body with a small wire bent up into a loop. If 
the patient is a child, it is advised by some to invert the 
body before attempting to remove a foreign body from 
the throat. If the thing which sticks in the throat is 
not too large, and is a piece of food, it may be pushed 
down into the gullet, or passage to the stomach. 

Things Swallowed. — Children occasionally swal- 
low marbles, coins, buttons, pencils, and a great variety 
of things. Generally they make the entire and crooked 
journey through the alimentary canal safely, and with- 
out much inconvenience to the patient, and are dis- 
charged with the natural contents of the bowels in from 



138 HANDBOOK. 

two days to a week. The insane, the delirious and the 
hysterical sometimes swallow a variety of indigestible 
things, and, ostrich-like, seem to relish the food. If 
the foreign body does not readily pass, and even when 
it does, the earliest symptom is pain in the stomach, 
shooting thence in various directions. Nausea and 
vomiting bloody mucus sometimes happen. The foreign 
body is apt to be arrested at the place where the small 
intestine opens into the large one, just above the groin 
on the right side of the bowels. In this event one of 
two things happens : it either ulcerates through, or an 
abscess forms at the place of lodgement. 

Pins, needles, pieces of glass, etc., frequently pass 
through the stomach and bowels, doing no harm ; in other 
cases they stop on their way, and begin to ulcerate 
through the tissues of the body, and at last may appear 
externally, and can be removed. Some very ugly things 
have been swallowed : breastpins, plates of false teeth, 
small knives, etc., in some cases causing death; in 
other fortunate cases, the foreign body, after a long 
time, makes its exit. We quote the following from Dr. 
Holmes' System of Surgery : 

"There is nothing more frequently swallowed and 
that intentionally, than pieces of money. The swindler 
in the streets of London, in the habit of passing false 
coin, when detected in the act, will invariably attempt 
to swallow the piece, and will generally succeed in the 
attempt, even if it be the size of half a crown. No evil 
effects occur in such instances. The treatment pur- 
sued by the man is peculiar and not irrationl. He avoids 
purgative medicine (physic) as worse than useless. On 



INJURIES. 139 

the other hand, he has recourse to a constipating diet, 
and feeds for some days on hard boiled eggs and cheese, 
in excess. His theory is, the more solid and copious 
the contents of the bowel, the more sure is the piece of 
money to be caught in the passing feculent matter, and 
thus will be more readily propelled onward to the ex- 
ternal outlet." 

Treatment. — The first thing most persons would do, 
in case a child had swallowed a coin or any such foreign 
body, would be to give a dose of physic. Such practice 
is wrong and does more hurt than good. 

It is much better practice to feed the child freely on 
coarse bread and much fruit, in order to fill the intes- 
tines and sweep the foreign body along through them. 
If the bowels remain constipated, on the fourth or fifth 
day a dose of castor oil may be given. Should the 
thing swallowed be large or very irregular in shape, 
some constipating food, such as toasted cheese, may be 
given. 

Teeth Knocked Out.— It frequently happens that 
several teeth are knocked out from a fall or from some 
other injury, but it is not generally known that they 
will, if returned, become quite firm again in the socket 
and remain a long time useful. They should be taken 
to a dentist who will push them back in place. They 
may be fastened in place by a silk thread tied around 
the other tooth. Even if the upper part of the socket is 
broken the tooth should be returned, for they may " grow 
in." 



140 HANDBOOK. 

Sunstroke or Heatstroke. — This subject is an 
important and practical one. Cases of Sunstroke are 
common during the heated season, and they call for 
prompt and intelligent treatment. The danger from 
these attacks is considerable. If sunstroke does not 
prove fatal within a few hours, it often leaves the patient 
in a bad condition of health. He may not be able there- 
after to bear any exposure to the rays of the sun in sum- 
mer, or he may suffer from almost constant headache, 
or from irritability of temper, loss of memory, partial 
paralysis, partial blindness, etc. The general health 
may be seriously impaired, or the person may lose his 
mind or become insane. Exposure to intense artincia' 
heat has the same effect as exposure to the hot sun ; on 
this account it is called heatstroke. There are three 
well marked varieties of Sunstroke, which we briefly 
explain : 

First. Heat fever. From exposure to intense sun- 
heat or artificial heat, a person may be struck down, 
and remain in an unconscious, or in a semi-conscious 
condition, with burning heat of the skin, which is usu- 
ally dry. The temperature of the body is high, 104° to 

110° F. The breathing is hurried and gasping. The 
face, head, and neck may be purple or red from ob- 
structed circulation. The pulse varies ; generally it is 
full, heavy and slow, or quick and jerking. There may 
be spasms, convulsions, or delirium. In many cases 
the patient falls into a profound coma, from which he 
cannot be aroused. 



INJURIES. 141 

Second. Failure of breathing. The nerve centers 
which control the breathing are overwhelmed by in- 
tense heat, and the patient dies for the want of breath, 
and from failure of the heart. The patient is uncon- 
scious ; the skin is cool, and the pulse feeble. He ap- 
pears very much like a person suffering from a Shock. 
Recovery, partial or entire, may take place. 

Third. Heat exhaustion, or syncope (fainting). Great 
depression of the nervous force and of muscular power 
may occur while a person is exposed to heat, if he is 
fatigued or has over-exerted himself. A condition simi- 
lar to fainting follows. The skin is pale, cool, and 
moist, the pulse quick and feeble. Death may take 
place from heart failure, or the patient may soon rally 
from this condition. 

We are aware of the danger of confusing a subject by 
making too many fine distinctions, but it seems neces- 
sary that these different varieties should be recognized. 
They are the key to treatment. The usual directions, to 
dash cold water upon a person suffering from sunstroke, 
if followed in a case of heat fever would be good ; but 
if the person was suffering from heat exhaustion, such 
treatment would be positively harmful, and worse than 
no treatment. Perhaps the only distinction that can be 
plainly made will be that the patient's skin is intensely 
hot, and that his pulse is full and strong. This would 
throw the case into the first class (heat fever), and 
plainly call for the cold water treatment. The pre- 
monitions may be slight, or wanting in some cases. Dr. 



142 HANDBOOK. 

Swift thus describes the attack : "The patients are sud- 
denly seized while in the performance of their labors 
with pain in the head, and a sense of fulness and op- 
pression in the epigastrium (region of the stomach) oc- 
casionall} 7 nausea and vomiting, general feeling of weak- 
ness, especially of the lower extremities, vertigo (dizzi- 
ness), dimness of vision and insensibility. Surrounding 
objects appear of uniform color." 

The attack may be slight, the patient remaining in- 
sensible for a brief time only, or he may become coma- 
tose. In the forms characterized by great heat of skin, 
the pulse is at first usually full and strong, but if the 
case proves fatal, the pulse becomes rapid and feeble. It 
has been thought of late that one who remains quiet 
when exposed to heat is more likely to suffer from heat- 
stroke than he is while in motion. This case seems to 
show it: A boy falling asleep in the sun, while the mer- 
cury stood at only 88° F. in the shade, soon became un- 
conscious, and, although efforts were made to resusci- 
tate him, lie died. Another case illustrates the effects 
of artificial heat. A person fourteen years old, suffer- 
ing from a rheumatic disease of the knee joint, was in- 
duced by a quack doctor to submit to his treatment. 
He was placed in bed, wrapped in a sheepskin taken 
from a sheep just killed, and packed about with loaves 
of bread fresh from the bakery. The person became 
unconscious after a short time, and died in three hours, 
probably from the effects of heat while in a fixed atti- 
tude. Though it may be true that a person remaining 



INJURIES. 143 

quiet when he is exposed to heat is apt to receive a 
stroke from heat, yet violent exercise in a heated apart- 
ment or in the hot sun is attended with great danger. 
One who is perspiring is in less danger than he is if his 
skin is hot and dry. 

Treatment of Sunstroke. — Examine the patient care- 
fully to find whether his skin is very hot and dry, and 
whether the pulse is full and bounding. When this is 
plainly the case, cold water should be poured upon him, 
upon his face, head, neck and body, in order to cool 
the superheated body as soon as possible ; or, if the 
conditions favor, the clothing may be rapidly removed, 
and the patient laid on the floor, upon a blanket with a 
sheet thrown over him. From an ordinary sprinkler 
cold water may now be poured over him till the skin 
becomes cool ; then he should be rubbed dry and placed 
in bed. When there are good facilities, a person maybe 
placed at once in a cold bath. If, after the temperature 
is reduced, there is exhaustion and a feeble pulse, stim- 
ulants in small amounts are called for. Such is the 
treatment of a typical case of heatstroke, when the ani- 
mal heat is unnaturally high. In sharp contrast to this 
treatment is that required in cases of heat exhaustion, 
fainting or syncope, from exposure to heat, when the 
skin is cool and moist, and the pulse feeble and rapid, 
when the bodily temperature is not abnormal. Cases of 
this kind frequently occur from exposure to heat. The 
heart and the nervous system are depressed. Rest and 
quiet in a cool place, and mild stimulants are indicated ; 



144 HANDBOOK. 

cold water should never be used, except on the head if it 
is hot and aches. 

Precautions. — If one is working in a heated apart- 
ment, or is exposed to the hot rays of the sun, he should 
give instant heed to the premonitions of danger, which 
are a peculiar headache or a feeling of pressure in the 
head, weakness and langor, oppression at the pit of the 
stomach, nausea, weakness of the legs, disturbances of 
vision, etc. If these warnings appear, the proper thing 
to do is to retire to some cool place, bathe the head in 
cold water and avoid further exposure. The use of al- 
coholic drinks predisposes to sunstroke ; persons ad- 
dicted to it must beware of continued exposure to heat. 
Black clothing, as a matter of precaution, must not be 
worn on hot days. There is more danger in hot, clamp 
days, than in hot, clear days. It is beneficial in a 
heated term to drink freely of cold water (not iced) . 
It promotes perspiration and helps to keep the body 
cool. Violent exercise, if long continued on hot clays, 
is dangerous. If one is obliged to work in an over- 
heated room, always arrange to have a draught through 
the room. A person who has once suffered a sunstroke 
must be extremely careful thereafter about exposure to 
heat. 



INJURIES. 145 



POISONS AND POISONING. 

Directions for the prompt treatment of cases of poi- 
soning should have a conspicuous place in a book of this 
kind. There is, perhaps, no emergency in which a little 
knowledge and immediate action are more urgently re- 
quired. Time spent in waiting for a doctor, unless he 
is near at hand, is costly ; it may cost the patient his 
life. 

So many poisonous substances are now used in the 
arts and manufactures, are kept in the house as medi- 
cines, and are so often taken with suicidal intent, that 
cases of poisoning are not infrequent. 

" What to do first " is in many cases plain and simple, 
and the medicines and means needed are often at hand. 
Too many fine distinctions and directions for the use of 
chemical antidotes only encumber and confuse the non- 
medical mind ; we therefore give plain directions, and 
describe the use of common remedies for the prompt 
treatment of acute poisoning. 

Most poisonous substances may be, for practical pur- 
poses, divided into two classes,* namely : 

1. Irritant Poisons. 

2. Narcotic Poisons. 

1. Irritant Poisons are those which irritate, burn, or 
destroy the parts with which they come in contact. If 



* There are certain poisons which cannot strictly be placed in either of these 
two classes; they partake somewhat of the nature of both kinds; they are 
called Aero -nareotic poisons. 



146 HANDBOOK. 

a person previously in good health, after eating or drink- 
ing, should be seized almost instantly with nausea, 
vomiting and purging, and with great distress or burn- 
ing pain in the stomach and bowels, attended with great 
prostration, there would be grounds for suspicion that he 
had swallowed some irritant poison. If the name was 
not known, the symptoms would indicate its nature. The 
most common irritant poisons taken by mistake or with 
suicidal intent are Arsenic in its various forms, such as 
the while powder, Paris green, Scheele's green, Bough on 
Mats, or other rat poisons ; the preparations of Mercury, 
such as corrosive sublimate, red precipitate, and vermil- 
ion} the sugar of lead and red lead ; the strong acids; 
nitric, sulphuric, muriatic, oxalic, etc. ; the strong alka- 
lies; caustic p>otash, soda, lime, lye, and the water of 
ammonia and liniments containing the latter. 

2. Narcotic Poisons produce effects entirely different 
from the irritants. The patient does not feel pain ; he 
gradually becomes dull and stupid, and may fall into a 
stupor, from which he cannot be aroused. The common 
narcotic poisons are opium and its preparations, bella- 
donna, aconite, henbane, digitalis, strychnine, chloral hy- 
drate, alcohol, ether, chloroform, etc. Of these, opium 
and its preparations are by far the most common poisons 
of this class. 

The following arrangement shows in juxtaposition 
these differences in symptoms : 



INJURIES. 147 

IRRITANT POISONS. NARCOTIC POISONS. 

Effect immediately noticed. No immediate effect. 

Burning pain in the throat and No pain; freedom from previous pain. - 
stomach. 

Nausea, vomiting and purging almost Nausea and vomiting uncommon, 
constant. 

The first effects are local— in the throat The first effects are constitutional, 
and stomach. 

Faiutness or Shock present to some Often stupor and insensibility, or con- 
extent, but mind clear. fusion of mind. 

General Treatment. — 1. Unknown Poisons. If, after 
eating or drinking something, symptoms of poisoning 
come on, the first and most sensible thing to do is to 
empty the stomach of its contents at once. Compel the 
patient to drink large quantities of tepid water, then 
thrust the finger or a feather down the throat; if this 
does not provoke copious vomiting, stir a tablespoonful 
of ground mustard, or two of salt, in a cup of water, 
and give, repeating every ten minutes till vomiting 
takes place. If the Sulphate of Zinc is at hand, give 
one-half teaspoonful doses in water every ten minutes ; 
this is the best. Syrup of Ipecac may be given freely. 
This can be done while somebody is running in great 
haste for the nearest doctor. If there is great prostra- 
tion, cold extremities, pallor, and a cold sweat upon the 
skin, the patient is in a condition of Shock, and needs 
warmth to the skin and stimulants. Strong tea or 
coffee, without milk or sugar, answers a good purpose, 
for either is a good antidote to many poisons. But the 
symptoms will generally indicate to which class the poi- 
son belongs. 

2. Irritant Poisons. — When the poison swallowed is 



148 



INJURIES. 



known to be an irritant, or when the symptoms plainly 
show that it is, the best treatment is to fill the stomach 
with some liquid that will absorb and dilute the poison ; 
then by emetics, elsewhere described, thoroughly empty 
the stomach, after which bland drinks may be given 
for the purpose of soothing the irritated lining mem- 
branes. Magnesia, powdered chalk, plaster, charcoal, or 
whitewash scraped from the plastering and stirred into 
water act as absorbents. 

3. Narcotic Poisons. — When it is known that a nar- 
cotic has been taken, or when the sjnnptoms indicate it, 
the treatment should be entirely different, excepting in 
one particular : vomiting should be immediately induced 
the same as above, for the purpose of getting all the poi- 
son possible out of the stomach. The danger from nar- 
cotics is that they may so oppress and stupefy the brain, 
nervous system, or heart, that death may take place on 
this account. Stimulants and warmth are generally 
needed. 

Special Treatment. — Opium, Laudanum, Morphine, 
Paregoric, and Soothing Syrups are guilty of producing 
the majority of the cases of narcotic poisoning, because 
they are common medicines, and often taken in over- 
doses. Old people and infants are very susceptible to 
their poisonous effects. After an overdose the patient, if 
previously in pain, gets easy, and gradually falls into a 
deep sleep, from which it is difficult to arouse him. The 
pupils of the eyes become narrowed to a "pin hole." 
The patient sweats, and his breathing grows very slow. 




A New York druggist has suggested that a human skeleton 
be placed at the prescription counter, to remind the com- 
pounder of medicines constantly of the possible results of 
carelessness in the use of poisonous drugs. 



INJURIES. 149 

There is then great clanger. Give an emetic and send for 
a doctor. Give strong coffee repeatedly. Whip the pa- 
tient's bare arms and legs to produce pain, which is the 
best antidote. Keep the patient awake, if possible, and 
walk him round in the open air. 

Arsenic is an irritant poison, and in some form is 
probably the poison most frequently given with criminal 
intent ; it is often taken accidentally. This is partly be- 
cause it is almost tasteless. Arsenic is also used as a 
medicine, often in the form of Fowler's Solution. 
Scheele's green is the coloring matter in wall-paper, 
artificial flowers, candy, paper boxes, toys and knick- 
knacks. Paris green is extensively used by farmers in 
killing potato-bugs. Fly-papers and rat-poisons con- 
tain arsenic. Realgar and Orpiment also contain it. 

The symptoms of poisoning come on in from a few 
minutes to an hour after the poison is taken, and are at 
first a burning pain in the throat, gullet and stomach, 
followed by vomiting, pain in the bowels, purging, in- 
tense thirst, coldness of the extremities, cold sweats, 
cramps, weak and irregular pulse, and Shock. 

Treatment. — Give large draughts of warm water, 
which assist vomiting ; emetics are not needed if free 
vomiting occurs at once, spontaneously. 

After vomiting, a large dose of castor oil should be 
given. If not at hand, some other oil may be substi- 
tuted. A mixture of chalk or magnesia and castor oil is 
highly recommended. The hydrated sesquioxide of iron 



150 HANDBOOK. 

is considered the best antidote ; it can be obtained of any 
druggist. 

Strychnine or Nux Vomica has an intense, bitter taste. 
It is used as a medicine. Dog buttons contain strych- 
nine. After the lapse of from two to twenty minutes, 
unmistakable signs of poisoning are seen, if the poison 
is swallowed. 

At first a stage of restlessness and excitement, and a 
sense of choking or suffocation ; vomiting does not usu- 
ally occur. Jerkings of the head and limbs soon set in ; 
in a moment the whole body is stiff and rigid. The 
limbs and different parts of the body become tense and 
fixed. Lockjaw is common. The symptoms are so 
plainly marked that a case is easily known. 

Treatment. — The stomach should be emptied of its 
contents immediately with some emetic. Large doses 
of bromide of potassium are recommended. The patient 
should be kept away from all noises and draughts, and 
should be touched or handled as little as possible. 

Belladonna, Atropia (deadly-nightshade) is in common 
use as a medicine, and is highly poisonous in large doses. 
The pupils of the eyes are widely dilated (opium con- 
tracts them) ; the throat is dry, and there is great thirst ; 
the face becomes dusky red ; the patient cannot see 
well ; there are hallucinations, and a busy and merry 
delirium ; in severe cases coma comes on. Recovery 
often takes place if the dose is not very large. 

Treatment. — Empty the stomach immediately. Give 
large doses of lime water, chalk, or charcoal ; if the 



INJURIES. 151 

skin is cool and the circulation fails, apply artificial 
heat and give stimulants. Opium is considered by some 
an antidote. 

Hyoscyamus (henbane), Conium (pcison hemlock) 
Stromonium (thorn apple, jimson weed), are all used as 
medicine and cultivated as ornamental plants ; they are 
poisonous in overdoses, with effects almost identical 
with those of Belladonna described above. The creat- 
ment is the same. 

Digitalis (purple foxglove) is poisonous in large 
doses. It produces a feeble and fluttering pulse, faint- 
ness, nausea, vomiting and stupor. Stimulants, such 
as ammonia, brandy, coffee, etc. should be given and 
external warmth applied to the body. 

Solanine. This poisonous substance is mostly found 
in the buds and green fruit of potatoes and in unripe and 
diseased potatoes ; the effect of the poison is the same 
as that produced by belladonna ; the treatment the 
same. 

Toisonous Plants. — There are other wild and culti- 
vated plants which when eaten produce narcotic poison- 
ing that must be treated as described above. 

Tincture of Aconite (monkshood) is kept in many 
houses as a common remedy for colds and feverishness. 
It is a subtile and deadly poison in a large dose — one tea- 
spoonful for instance. Children are poisoned by chew- 
ing the leaves of monkshood. The effect of the poison 
is to weaken and slow the action of the heart. After 
swallowing a large dose there is burning in the throat 



152 HANDBOOK. 

and stomach and soon a tingling and numbness is felt 
over the body. The pulse becomes slower than natural. 
There is no real antidote. At first give an emetic, then 
tablespoonful doses of powdered charcoal, and follow 
by stimulants. Keep the patient very quiet and on no 
account allow him to sit up or try to walk because there 
would be danger of fatal syncope or heart failure. Stim- 
ulants are plainly needed when there is a tendency to 
heart failure. 

Oxalic Acid is a deadly poison destroying life in a 
short time when taken internally in considerable amount 
unless vomiting is immediately indTrced. It is some- 
times mistaken for Epsom salts. Oxalic Acid when 
swallowed causes pain in the throat, gullet and stomach. 

Treatment. — An emetic should be taken and assisted 
in its action by large draughts of tepid water. Powdered 
chalk, magnesia or whitewash scraped from the ceiling 
and mixed with water may be taken in large quantities. 

Strong Acids. — If a person drinks by mistake a strong 
acid he will find it out immediately. He should drink 
immediately a cup of water with much soda, saleratus, 
magnesia, lime-water or whiting stirred into it, or if 
nothing else is at hand soft soap and water is better than 
nothing. Vomiting should be induced, after which give 
the whites of eggs freely. 

Tainted Meat or Fish, Sausages and Cheese, and other 
kinds of food sometimes produce symptoms of poison- 
ing. The recently discovered substance called Ptomaine, 
the product of putrefaction, is supposed, at the present 



INJURIES. 153 

time, to be the poison in such cases. The symptoms 
are very much like those noticed in cases of cholera mor- 
bus. Emetics or active physic is the proper treatment 
at first ; perhaps an opiate will be needed to allay the 
pain. 

Mushrooms (toad stools). — These to some people are 
a delicious food, but some varieties are poisonous and 
can be known by their dark color, acid bitter taste, pun- 
gent odor, and from the fact that they grow in damp 
dark places. Symptoms of poisoning come on after an 
hour or two, such as drowsiness, dizziness, dimness of 
sight, delirium, colic pain, vomiting and purging. The 
treatment is the same as that for tainted meat poisoning 
above described. 

Poisonous Vegetables. — Rotting or unsound vegetables 
or fruits eaten in considerable quantities, and in hot 
weather, infrequently produce poisonous effects, such as 
pain, vomiting and diarrhoea. The symptoms are nearly 
the same as those observed in tainted meat and fish 
poisoning. 

If the offending substance is not ejected from the 
stomach by the act of vomiting, an emetic should be 
given, followed by a Seidlitz powder or a dose of castor 
oil. When the pain is very severe it better be controlled 
by a few doses of paregoric or some other anodyne. 

Alcohol, in sufficiently large doses, is a poison, from 
the effects of which a person may die. It should be 
known that there is considerable danger to life when a 



154 



HANDBOOK. 



young person is profoundly intoxicated or poisoned with 
alcohol. 

Treatment. — If a person is found soon after drinking 
large amounts of spirituous liquor, and is in a condition 
of "rum coma" — dead drunk, an attempt should be 
made to produce vomiting by the use of emetics. If 
the patient can be compelled to drink warm water, large 
amounts should first be given. After vomiting, give 
aromatic spirits of ammonia every one-half hour and 
apply iced- water to the head. Slap the bare legs with a 
wet towel. 

We give below in tabular form the antidotes and 
treatment for common poisons, selected in part from a 
table in the Scientific American. 



POISONS. 

Acid— Carbolic, sulphuric, nitric, mu- 
riatic, nitre-muriatic, creasote, io- 
dine, phosphorus. 



Chromic acid, chromates, all prepara- 
tions or compounds of chromium, 
antimony, copper, mei'cury or zinc. 



Ammonia, soda, potash, alkaline, sili- 
cates aud sulphates. 

Prussic acid and its salts, all cyanides 
and sulpho-cyanides, oil of bitter 
almonds and nitro-benzine. 



Ether, petroleum, benzine, fruit es- 
sence, concentrated or absolute al- 
cohol. 



Compounds of baryta and lead. 



ANTIDOTES. 

White of egg well beaten up with 
water. A teaspoonful of mustard 
flour in a cup of hot water. Very 
thick lime-water — (in case of sul- 
phuric, nitric, muriatic or nitro- 
muriatic acids). 

Abundance of white of egg in water. 
A teaspoonful of mustard flour in 
water. Copious draughts of an in- 
fusion of salt herbs. 

Strong vinegar and water. Large do- 
ses of oil. Large doses of milk. 

Continuous and heavy douches of ice. 
cold water over the head and spinal 
column. Mustard plasters on the 
stomach and soles of the feet. Pre- 
vent sleep. 

Plenty of mustard flour in large quan- 
tity of hot water. Cold-water dou- 
ches. Fresh air. Prevent sleep ab- 
solutely. 

A teaspoonful of mustard flour in 
warm water. Strong solutions of 
Epsom salts and Glauber's salts in 
cold water. 



INJURIES. 



155 



POISONS. 

Compounds of arsenic, White powder, 
Pans green, Scheele's green, Rough 
on Rats. 



Oxalic acid and its salts. 



Nitrate of silver 



Nitrous fumes of vapors, arising in 
vitriol or chemical works. 

Opium, daudanum, morphine, pare- 
goric, and soothing syrups. 



Belladonna (deadly nightshade) , Hy- 
ojicyamus (henbane), Digitalis (fox- 
glove), Conium (poison hemlock), 
Stramonium (thorji apple). 

Tainted meat or fish, poisonous vege- 
tables, mushrooms. 



Strychnine, Nux Vomica. 



Corrosive sublimate, tartar emetic, 
bed-bug poison. 



Sugar of lead. 



Noxious gases, carbonic acid gas, car- 
bonic oxide, carburetted or sulphu- 
retted hydrogen, vapor of chlorine, 
etc. 



ANTIDOTES. 

A teaspoonful of mustard flour in 
warm water. A teaspoonful of di- 
alysed iron mixed with the same 
quantity of calcined magnesia every 
five minutes for one hour. Then 
plenty of oil, or milk, or some mu- 
cijaginous tea, say linseed. 

Very thick paste of lime and water 
by large spoonfuls at a time. 
After several of these, large draughts 
of lime-water. Finally, 4 ounces 
castor oil. 

Large doses, of ordinary kitchen salt 
dissolved in water, after which one 
teaspoonful of mustard flour in 
warm water. 

Frequent and small doses of strong 
acetic acid — the stronger the better. 

Emetic, if poison just taken, then 
strong coffee; slap the bare skin 
with towel wet in cold water, to 
produce pain, keep the patient 
awake and walk him round; arti- 
ficial respiration. 

G-ive emetic first, then powdered 
charcoal. Stimulants if rapid fail- 
ing. 



Give an emetic, then castor oil or 
Seidlitz powders. 

Give an emetic, then a large dose of 
castor oil. 

Emetics, whites of eggs, strong tea or 
coffee. 

Provoke vomiting, then give Epsom 
salts. 

Fresh air, if stupor dash cold water 
on the body, artificial respiration. 



Precautions. — All medicines known to contain poison 
should be thrown out as soon as what is needed has 
been used. All bottles containing laudanum, tincture of 
aconite, ammonia, carbolic acid, sulphuric acid, oxalic 
acid and so on, should be plainly labelled poison. It 
has been suggested that peculiar looking labels be put 



156 HANDBOOK. 

on such bottles. Druggists put on the skull and cross- 
bones-sign. One in a hurry might easily mistake these 
poisonous liquids for something else ; such mistakes are 
of too frequent occurrence. 

Generally, one should " go slow" in swallowing the 
contents of vials not labelled. Liniments containing 
poisonous ingredients are quite often taken by mistake. 

Great care must be observed in giving opiates to aged 
persons and to children. As soon as pain is relieved, 
and a sleepy, dull condition comes on, the medicine 
must be omitted and the patient watched Beware of 
giving large amounts of soothing syrups to infants . 

Ice-cream Poisoning. — Cases of this are not very 

common, but they do occur. Whole families, and large 

numbers of picnic parties, have been poisoned in this 

way. In a daily paper of yesterday the following item 

appeared : 

"At a picnic given at Pilot Point, Texas, yesterday, 
a large number of people were poisoned by ice cream 
made poisonous by staying too long in the cans. Fif- 
teen persons will die." 

Great differences in the cases with respect to severity 

are noticed. Some are mild, recovery taking place in a 

short time ; others are very severe and terminate fatally. 

Just what the poison is, or how it gets into the cream, 

has been a difficult question to settle and perhaps it is 

not yet fully settled. The poison was supposed at one 

time to be vanillin, at another time, zinc, resulting from 

some chemical or galvanic action upon the zinc of the 



INJURIES. 157 

freezer. At the present time the majority of physicians 
are agreed, we think, that the poison is Ptomaine, which 
is the product of putrefactive changes in the milk from 
which the cream is made. It is thought by some that 
the cream or milk is tainted, and that putrefaction is 
started by neglecting to cleanse the freezer thoroughly. 

The symptoms of poisoning do not generally come on 
till an hour or two has passed after eating. There is at 
first a feeling of pressure or fulness in the stomach and 
sometimes dizziness and faintness to which pain, nausea 
and generally vomiting are added. Diarrhoea is also a 
common sjmiptom. The attack appears very much like 
a case of Cholera Morbus when severe. Other cases are 
so mild that there is little resemblance. 

Treatment. — When there is suspicion that a poisonous 
ice-cream has been eaten, if spontaneous vomiting has 
not already taken place, an emetic should be immediately 
taken and followed by some active cathartic. In case 
pain is very severe and persistent, it should be controlled 
by some anodyne. No specific antidote is yet known. 
The purpose of treatment is to remove the poison from 
the stomach and bowels, and to allay the irritation. 

Ivy Poisoning. — Many persons are so susceptible to 
this kind of skin poisoning that they cannot walk among 
the plants or vines or even pass where they are growing 
abundantly without harm. 

There are two kinds of plants which produce it. 

1. The Poison Ivy vine. — This resembles the ordinary 



158 



HANDBOOK. 



woodbine, climbing in the same way over walls, fences 
and trees. It may be distinguished by bearing in mind 
the very simple rule that the harmless vine has five 
leaves on a stem, while the poison ivy has but three. 
The poison ivy grows also as a small, branching herb, 
with green shining leaves. Between this and the vine 
there are many intermediate grades. In the autumn the 
leaves take on variegated and beautiful colors. 

The Poison Oak, known also as the poison sumac, 
sicamp sumac, dogwood and poison elder. It must be 
distinguished from the common sumac of uplands, which 
is harmless. The poison sumac is a tree six to eighteen 
feet high, bearing dark green, pointed, shining and 
smooth leaves. The flowers are small and greenish ; the 
berries greenish white or yellow. The berries of the 
harmless sumac are always crimson red. The leaves of 
the swamp sumac in autumn are more brilliant and 
beautiful than those of any other tree. 

The eruption from such poisoning appears first in 
minute, itching pimples, which soon change into water 
blisters (vesicles) . When these are broken by the al- 
most inevitable scratching, the skin becomes raw and 
moist, or scabs ma} T be formed ; it is a form of Eczema, 
and is very troublesome unless promptly cured. 

Treatment. — A writer in the Popular Science News 
states that he was always susceptible to this poison and 
greatly annoyed by it till he learned to check it in the 
following way : saturate a slice of loaf bread with water, 
then spread on one side of it common washing soda, and 



INJURIES. 159 

apply to the poison patch of skin. When the bread 
becomes dry, moisten it again ; keep on one-half hour. 
This is a kind of bread poultice. The remedy should be 
applied immediately on the appearance of the humor to 
do the best. 

The bruised leaves of the common plantain bound on 
is a good remedy. 

A wet cloth, upon which fine salt has been sprinkled, 
often cures. 

Soft soap also affords great relief. Carbolized vase- 
line or cosmoliue freely and repeatedly rubbed upon the 
eruption is one of the best remedies. 

Sulphite of Soda dissolved in water is very highly 
recommended. 

The following prescription is said to afford immediate 
relief. 

B 

Carbolic Acid grs. x 
Powdered Borax 3 ii 
Vaseline 3 i 

Mix and apply on a soft cloth three or four times a 
day. 

The oxide of zinc ointment is one of the best reme- 
dies to apply when the humor begins to heal. 

Alum-curd is a popular remedy with some physicians. 



160 HANDBOOK. 



CANNED MEAT POISONING. 

Cases of poisoning from eating canned meat occasion- 
ally occur, but they are not common. The meat may 
have been tainted before it was canned, or it may have 
been improperly canned. 

The symptoms and treatment of canned goods poison- 
ing are the same as for meat poisoning when not taken 
from cans. (See page 152) The following simple 
rules about the use of canned goods may be useful in 
preventing poisoning of this kind. 

1. Reject all meats that are contained in corroded 
cans. 

2. Reject all cans that have the ends pushed out by 
gas contained within. 

3. If there is the least taint discovered on opening the 
can, reject it. 

4. On opening the can, remove the contents immedi- 
ately and keep in a cool place. 

5. Remember that fresh meat canned will " spoil " 
after the can is opened as soon as any meat. 



SUDDEN ATTACKS. 161 



PART III. 

SUDDEN ATTACKS. 

SPASMS, FITS AND CONVULSIONS. 

If some member of the family suddenly falls into a, 
convulsion, and if it is the first case in the household, it 
makes an emergency for which the average family is 
poorly prepared. A messenger is sent in the greatest 
haste for the doctor, but he may not be at home. To 
aid the inexperienced in the diagnosis and treatment of 
these sudden convulsive attacks, we describe the most 
common kinds, and point out some sensible things that 
may be done in the absence of a medical man. 

It may be said here that convulsions are by far the 
most frequent in infancy and childhood. With the ex- 
ception of epileptic and hysterical fits, convulsions in 
adults are uncommon ; when they do occur, they are, as 
a rule, of a very bad omen, signifying something more 
formidable than those which occur in the early periods 
of life. 

Convulsions in Children. — Diseases of the ner- 
vous system are extremely frequent during the early 
periods of life. The rapid development of the brain and 
spinal cord, and the great activity of the circulation 



162 HANDBOOK. 

account for this in part. From birth to the seventli 
or eighth year there is what some physician has called 
u an undue mobility of the nervous system." 

Slight irritation in any part of the body is a sufficiently 
exciting cause for spasmodic and convulsive attacks. In 
the majority of coses, when they are not produced by 
organic disease of the brain, or epilepsy, they leave no 
bad results ; but if they occur frequently, they are apt to 
weaken the intellect and impair the child's general 
health. 

Inward Fits. — We judge that this term is more com- 
mon in England than in this country ; by it is meant a 
slight spasmodic affection of infants. The infant lies 
as if asleep ; the eyes are imperfectly closed ; the muscles 
of the face twitch, particularly those about the mouth, 
which is often drawn into the semblance of a smile ; 
"poets have told us that it is the 'angels' whisper' 
which makes the babe to smile — a pretty conceit of 
which we can scarcely forgive science for robbing us." 

These inward fits may possibly be the premonitions of 
a real convulsion, but generally they depend upon indi- 
gestion or wind in the stomach and bowels as a cause. 
A little aromatic drink — ptppermint water or catnip tea 
will usually cure the trouble. 

Nine-day Fits. — (Infantile Lock-jaw) . This is the 
first disease in point of time which seizes the little 
stranger after his advent into this world. The spasm 
usually attacks infants less than two weeks old. The 
most common causes are want of cleanliness and un- 



SUDDEN ATTACKS. 16$ 

healthy surroundings. It gets its name from the fact 
that the attack lasts about nine days. The spasm is some- 
times preceded by a little stiffness of the jaws and a 
difficulty in nursing. When the spasm is fully formed, 
the jaws are locked ; the legs are drawn up and rigid ; 
the arms are bent up ; the head is thrown backward and 
the whole body is rigid. To the ordinary observer the 
attack would pass for a simple fit but it is different, 
and much more dangerous. The spasm may last several 
hours, then remit. The attack proves fatal in nearly 
every case. 

Child Crowing is a sudden spasmodic attack — a 
momentary and involuntary suspension of the breathing, 
followed by a noisy and crowing inspiration. The at- 
tacks are at irregular intervals, and not attended with 
fever or cough. It is something different from the 
ordinary " holding the breath " which happens when the 
child is crying in anger. It is a real spasmodic disease 
and has had different names — Spasm of the Glottis, In- 
ternal Convulsions, etc. Undoubtedly many mothers 
have noticed in their infants the phenomena of the dis- 
ease while the}?' were ignorant of its name and real na- 
ture. The paroxysm is similar in its nature to an ordi- 
nary partial convulsion and the treatment called for is 
about the same. 

General Convulsions. — Premonitory symptoms 
are noticed in some cases. The child seems unnaturally 



164 HANDBOOK. 

drowsy, and the head is hot. Sudden startings or 
twitchings of the limbs or of the muscles of the face 
occur. When the fit is about to begin, the child lies 
quiet with the eyes open and fixed ; they may be turned 
upward, or squinting may be noticed. 

When the attack comes on, the body becomes stiff and 
immovable. The muscles of the face twitch, the mouth 
is distorted. The face is at first pale, then it becomes 
livid or black, as the saying is. The breathing becomes 
very irregular, noisy and laborious. The thumbs are 
turned in upon the palms, and the fingers clenched upon 
them. The pulse is rapid and small. At the end of 
one or two minutes the spasms stop to return after a 
few minutes or to cease altogether. It should be known 
that the convulsion may be epileptic. Such is a general 
convulsion. The partial form is perhaps fully as com- 
mon. In this form spasms of the muscles of the face 
and of those about the eye, and it may be those of one 
side of the body, occur, but the body generally is not 
convulsed. 

Causes. — Anything which over-excites the nervous 
system is likely to produce spasms. Diseases of the 
brain and of the spinal cord are well-known causes. In- 
digestion or irritation of the stomach or intestines, by 
fermenting or undigested food, the presence of worms, 
etc., are prolific causes of convulsions in infants and chil- 
dren. A change of milk in bottle-fed infants is some- 
times a sufficient cause. A change of the breast milk of 
the mother from sickness, anger, fright and other causes 



SUDDEN ATTACKS. 165 

has been followed by convulsions in the infant. Teeth- 
ing, fright and exposure to cold are exciting causes in 
infants predisposed to nervous diseases. 

Another class of cases is made up of those convul- 
sions which occur at the beginning of Scarlet Fever, 
Measles, Cholera Infantum, Pneumonia, etc., and at the 
close of these diseases. Convulsions are apt to take 
place during the course of Whooping Cough. 

Treatment. — It is fortunately the case that all convul- 
sions in children require nearly the same treatment and 
that the most important things can be done by any in- 
telligent person. First the child's feet and legs should 
be put into a hot bath, to which mustard may be added. 
If not too much delay is required, it is, perhaps, better 
to put the child's body into a hot bath ; it has a sooth- 
ing effect, and somewhat relaxes the muscular spasms. 
Cold water must be applied to the head until it seems 
cool. 

As, in the majority of instances, the fit results from 
an unhealthy condition of the stomach and bowels, an 
emetic should be given as soon as the child can swallow. 
This simple remedy will, in a great many cases, effect a 
speedy cure. Another measure of great importance is 
to secure at once free action of the bowels. An injec- 
tion of warm soapy water will generally produce a 
prompt evacuation. 

These steps in the treatment of an ordinary case of 
convulsions are certainly judicious, whether they are 
taken by a doctor himself, or in his absence. In many 



166 



HANDBOOK. 



instances the writer has found these measures alone 
sufficient to a speedy relief. While these things are be- 
ing done, the family physician will probably arrive who 
can direct such other treatment as the particular case 
may require. 

Generally speaking, ordinary convulsions in children 
are not attended with immediate danger. 




SUDDEN ATTACKS. 167 



EPILEPSY. 



This has various other names : The Falling Sickness, 
Fits, Grand Mai of the French. If a person has been 
subject to fits coming on every few weeks, or at 
longer intervals for a long time, no mistake would be 
made generally in calling them epileptic. Epilepsy has 
been known and described in medical writings since the 
most ancient times. It was called by the Greeks the 
" sacred disease," because they supposed the gods had 
a special influence over epileptics. The ancients thought 
that an evil spirit had taken up his abode in the body, 
and they tried to frighten him out by loud noises, or to 
entice him out by charms and incantations. 

In modern times Epilepsy is regarded as a real dis- 
ease of the nervous system. It is characterized by a 
sudden loss of consciousness and general convulsions 
followed by Coma. In the majority of cases it begins 
between the tenth and twentieth years, and is rarely 
cured. 

The attack is sudden and with or without warning:. 
The patient makes a peculiar noise, or utters a piercing 
scream, and falls to the ground unconscious, and falls 
into a violent convulsion. The muscles of the face are 
frightfully contorted ; bloody foam collects in the mouth 
and on the lips ; the eyes are open and either fixed or 
in constant spasmodic motion ; the head is thrown back- 
ward or to one side ; the breathing is very irregular, or 



168 HANDBOOK. 

laborious and noisy. After a minute or two the face 
becomes livid ; the limbs and other parts of the body are 
in spasmodic action. The fits last from five to eight 
minutes or may be much longer. 

Gradually the patient falls into a deep stupor or sleep, 
from which he wakes exhausted and without knowledge 
of what has happened. 

Real epilepsy is usually preceded by warnings, which 
are called epileptic aura. They are of various kinds : a 
sensation as if cold water was being poured upon the 
limbs ; or as if a puff of cold air was being blown upon 
them ; or as if insects were creeping over the body. 

" Dr. Gregory, of Edinburg, was assured by an epi- 
leptic that when a fit was approaching, he fancied that 
he saw a little old woman in a red cloak advance towards 
him, and strike him a blow on the head, on which he at 
once lost all recollection, and fell down." A sharp pain 
may begin in one extremity and pass upward to the 
head. When any of these sensations stop, the fit be- 
gins. But there are many persons who do not have 
warnings or else do not notice them. 

Besides epilepsy in its typical form there is another 
form which French writers call Petit Mai. This consists 
of a loss of consciousness for a brief time, attended with 
slight spasms of certain muscles of the face, tongue, 
throat, eyes or neck, but with no falling fit. 

There is another convulsive attack which is liable to 
be mistaken for it — the hysterical fit. 



SUDDEN ATTACKS. 169 

The following table shows the points of distinction by 
the different symptoms : 

EPILEPTIC PIT. HYSTERICAL PIT. 

Sudden and complete loss of con- Gradual or apparent unconsciousness, 
sciousness. 

Livid face; escape of bloody mucus Face flushed only, or unchanged; no 
from mouth; eyelids half open; froth on lips; eyelids closed and 

eyeballs rolling. eyeballs fixed. 

Patient manifests no feeling. Patient sighs, or laughs, or sobs. 

Paroxysms short. Paroxysm of longer duration. 

Paroxysm folio wed by stupor and dull Paroxysm not followed by stupor, 
intellect. but often by crying or laughing. 

No sensation of choking just before Sensation of choking or globus hy- 
the attack. Aura. stericus — ball in the throat. No 

aura. 



This contrast of symptoms, if carefully studied, will 
plainly indicate the nature of the attack, and be a guide 
to the treatment. 

Treatment. — Nothing can be done in the way of treat- 
ment to cut short an attack. The most that a physician 
or a bystander can do at the time is to prevent the per- 
son from injuring himself. Persons who are old enough 
to understand should be taught to lie down as soon as 
any warning is noticed. As the attack is often sudden 
and without warning, the epileptic should never stand in 
dangerous places. 

By spasmodic action of the jaws the tongue is often 
badly bitten ; on this account it is advised to hold a 
stick or a roil of cloth or something of the kind between 
the teeth during the spasm, to prevent such injury. It 
is certainly true that death seems imminent during these 
epileptic convulsions, yet it is equally true that they are 



170 HANDBOOK. 

devoid of immediate danger to life, except from acci- 
dents. 

No attempt should be made by force to restrain the 
convulsive movements. The brain becomes congested ; 
after the fit, cooling applications to the head should be 
made. Some physicians advise to compress the carotid 
arteries against the spinal column to mitigate or to pre- 
vent an attack. First, compress the artery on the side in 
which the convulsive movements are less severe. 

The Bromide of Potassium or Sodium, in large doses, 
and continued for a long time, prevents the recurrence 
of the fits in some cases. 




Evolution of a drinking man. 



SUDDEN ATTACKS. 171 



HYSTERICAL CONVULSIONS OR FITS. 

No physician continues long in the practice of medi- 
cine without being called in haste to see cases of Hy- 
sterical fits. They are mostly confined to young fe- 
males ; they rarely attack middle-aged women, and in 
only the rarest cases nervous men. A little odium 
seems to rest upon these attacks in the minds of many 
persons, but there is no good reason for it. They are 
the uncontrollable vagaries of the nervous system. The 
will power seems to have become unshackled allowing 
the nerves to run wild. It is not in the power of the 
patient to calm at will these " nervous storms." They 
occur mostly in persons of an inherited nervous tempera- 
ment, and in those who are anaemic, or weakened from 
any cause. The fit is in nearly every case preceded by 
the hysterical condition. This consists of varied sensa- 
tions ;■ a painful sense of constriction in the region of the 
stomach ; a sensation as if a foreign body was ascend- 
ing from the abdomen to the throat, known as the glo- 
bus hystericus; or there may be unreasonable fits of 
laughing or crying. The paroxysm or fit comes on grad- 
ually. At first the breathing is spasmodic and jerking, 
or the patient appears as if she wns choking. Convul- 
sive movements are often first noticed in the eyelids or 
e}^eballs. Constant winking is common. The limbs are 
thrown round in various directions, but the movements 
seem to be partly under control. The patient resists 



172 



HANDBOOK. 



restraint, and often shows more than the strength of a 
man. In some cases she grasps her throat, or tries to 
tear her hair. The face is either flushed or unnaturally 
pale. The pulse is not changed from normal. The pa- 
tient, though apparently unconscious, knows more or 
less of what is going on about her. When she falls, it 
is in a safe place, and not into the fire or from an em- 
bankment, unlike epileptics. 

Gradually the storm subsides ; the spasms cease and 
the patient becomes quiet and seems exhausted ; she 
may fall into a crying or laughing fit. It often happens 
that the patient, after these convulsions, passes a large 
quantity of almost colorless water. 

Hysterical Coma sometimes makes a feature of the 
hysterical attack. It may precede or follow the real fit, 
or it may be the only symptom, or at least the principal 
one that constitutes the attack. 

In a case of simple hysterical coma the patient lies 
as if asleep, yet cannot be awakened. The breathing, 
the pulse, the countenance, do not appear unnatural. 
Occasional sighing is likely to take place. The arms and 
legs may be more or less rigid. The jaws cannot be 
opened always. Although this is called coma, it is the 
counterfeit of it ; the patient is cognizant in part of 
what is going on about her. Attacks of this kind may 
last several hours or clays, and they are alarming to 
those who do not understand their nature. The attack 
might be mistaken for apoplexy, ur'aemic coma (a 
symptom of Bright's disease), narcotic poisoning, a 



SUDDEN ATTACKS. 173 

state of " rum coma," or insensibility from drink, faint- 
ing, or possibly for a dying condition ; if so, the attend- 
ants would be needlessly alarmed, for hysterical seizures 
in their varied forms are proverbially free from danger 
to life. 

Hysterical Delirium. — .A celebrated medical writer of 
N. Y. City says in regard to this : 

"Hysterical delirium occurs generally subsequent to, 
or in alternation with, the paroxysms of convulsions or 
coma which have been described ; but it also occurs 
alone. It is preceded and followed by symptoms char- 
acteristic of the hysterical condition. The delirium is 
active, and is manifested in some cases by wild, excited 
talking, the mind passing rapidly from one topic to 
another. The mind may run on either gay or grave 
topics, or there may be an incongruous union of both. 
In some cases the mind acts under the influence of in- 
sane delusions and these sometimes involve spectral illu- 
sions." 

Hysteria has the power of mimicry ; other diseases may 
be so closely imitated as to deceive everybody. The hy- 
sterical person may appear to be suffering from peritoni- 
tis, inflammation of the bowels, spinal disease, heart dis- 
ease, and so on, when she has no real disease of the 
kind. 

A hysterical fit is " contagious;" for instance, if a 
girl in a hospital ward, or in an assembly in which there 
are other young women, should fall in a fit, several 
others within sight might be similarly attacked. 

Such is a brief and partial account of the hysterical 
attack. Its forms are protean and surprising. Some- 



174 HANDBOOK. 

times it is difficult to distinguish it from epilepsy. The 
points of distinction are given on page 169. 

Treatment. — A medical writer of high authority says 
that the quickest way and the most effectual means of 
bringing the patient out of a hysterical fit, coma or deli- 
rium, is to pour cold water from a little height upon the 
head and face till the paroxysm is cured. The same phy- 
sician advises that the attendants be assured in the pa- 
tient's hearing that she will certainly come out of the fit 
if the cold douche be continued long enough. This 
treatment is simple, the medicine is usually at hand, and 
it probably cures more speedily than other remedies. 
Physicians, however, seldom resort to it, because it 
seems " unfeeling " to the patient and perhaps to the 
family. But stern words and treatment do better in 
such cases than sympathetic ways, which often prolong 
the attack. For domestic treatment it is suitable, espec- 
ially for a girl who is in the habit of going into hysterics. 
The moral effect of it may deter her from them if she 
knows what the remedy will be. 

Asafcetida is celebrated for its effect in preventing or 
breaking up the attack. It should be given in pill form 
as soon as symptoms first appear. The pills can be ob- 
tained of any druggist. Valerian is a popular medicine 
in this disease. In the less severe form it may be 
sufficient. Hoffman's Anodyne is one of the very best 
medicines for the cure of hysterical attacks. About two 
teaspoonfuls should be given in one-third of a cup of 
Bweetened water every few minutes till there is marked 



SUDDEN ATTACKS. 175 

improvement. When the nervous system is in that ex- 
cited, unstable, hysterical condition which threatens a fit 
at any moment, the Bromide of Potassium in twenty 
grain doses every hour or two is the medicine plainly 
indicated. 

Catalepsy is closely allied to hysterical coma, but it 
is an extremely rare affection. A New York physician 
of very extensive hospital and private practice says he 
never saw a well marked case of it. It is of little prac- 
tical importance, but is generally described in medical 
books. Dr. Flint thus describes it: "The patient, 
while in this state, remains immovable preserving the 
position the body happened to be at the time of the at- 
tack. . . . The trunk or limbs are retained in positions 
which, in health, would require strong exertion of the 
will, and for a longer period than would be possible in 
health." The condition is nearly the same as that of 
the Mesmeric and hypnotic states. The attack may be 
short, or may continue for a long time. 



176 _ HANDBOOK. 



APOPLEXY. 

In common language this is called a Shock, Apoplectic 
Fit, or a Stroke of Palsy. The word Apoplexy means to 
14 strike away," that is, into an insensible state. An 
attack of this nature is rare in the young, but it is of 
common occurrence in those of advanced age — sixty 
and upwards. In the majority of the cases, the symp- 
toms are plain, and the nature of the disease is easily 
distinguished. 

Two principal causes are recognized. 

1. Rupture of a blood-vessel in the head, in conse- 
quence of which a clot of blood is pressed upon the 
brain. 

2. Congestion of the brain — called congestive Apo- 
plex} T — undue pressure of blood within the cranium. 

A fibroid growth is sometimes detached from the cavity 
of the heart, and swept along by the blood current till it 
reaches an artery in " the brain too small for it to pass 
through; the artery is thus plugged, and a condition al- 
most identical in its symptoms to that of Apoplexy results. 
We hear of persons having many Shocks, and still they 
are living. The attacks are of this kind ; not true Apo- 
plexy caused by a clot of blood. 



SUDDEN ATTACKS. 177 

Considering these several causes of the Apoplectic 
state, it may be more easily understood that the danger 
and gravity of the attack depend largely upon the cause. 
The symptoms may be misleading. The first cause — a 
clot of blood — is followed by the most disastrous conse- 
quences. If the patient survives the immediate danger, 
he will probably be more or less paralyzed, and remain 
an invalid as long as he lives. In a small number of 
the cases premonitory symptoms are noticed, such as a 
feeling of weight or fulness in the head, dizziness, ring- 
ing noises in the ears, flushing of the face, etc. ; but the 
same symptoms often occur in persons who do not sub- 
sequently have a Shock. 

The seizure is not always absolutely sudden. The 
patient may feel strangely for a few moments, partially 
losing his mind and his power of speech. When the 
attack is fully developed, the patient lies as if in a deep 
sleep ; his breathing is noisy and laborious ; the lips and 
cheeks are puffed out at each expiration ; the pulse is 
distinctive ; it is full, slow, and sometimes irregular ; 
the pupils of the eyes are changed, either dilated or con- 
tracted, or the two vary in size ; the eyes remain half 
open ; the mouth is drawn to one side, and one side of 
the body is paralyzed. The patient cannot swallow. 
The limbs are flaccid ; and when raised, fall passively to 
the ground. In some cases slight twitchings and spasms 
of the limbs are noticed, or there may be a convulsion. 
If the patient is to recover, he does so in a short time. 
A characteristic thing about the attack is that the tern- 



178 HANDBOOK. 

perature of the body is lowered, it being much different 
in this respect from sunstroke, in which attack the tem- 
perature is raised. Apoplexy is most likely to happen 
after a full dinner, or during sleep. 

Besides these severe and generally fatal attacks, 
others less severe are frequent. The mind may not 
be wholly lost, and other symptoms may be lacking, or 
slight, recovery taking place wholly or in part in an 
hour or two. But paralysis may continue for years. 

Such is an apoplectic fit. The attack must be dis- 
tinguished from others which it resembles, namely : 
Sunstroke, Fainting (Syncope), Insensibility from 
Drink or Narcotic Poisoning, Epileptic Coma, and Hy- 
sterical Coma. 

Sunstroke or Heatstroke has been described in a fore- 
going article, which see. It closely resembles apoplexy 
in its sudden attack and in the insensibility ; but there 
are plain marks of distinction. In Sunstroke, unlike 
Apoplexy, the skin is hot and dry at first ; the tempera- 
ture is high-=104 Q to 110° F. (in the common variety). 
The pulse is not so slow and full as it is in Apoplexy. 
In Heat Exhaustion the skin is usually cool, but unlike 
Apoplexy the pulse is rapid and small, and there is no 
paralysis or snoring breathing. On account of the 
differences in the treatment needed, it is important to 
distinguish the two conditions. 

Fainting (Syncope) . Fainting results from a tempo- 
rary weakening of the heart's action. Unlike Apoplexy 
it occurs most frequently in young women. The pulse 



SUDDEN ATTACKS. 179 

is very small or imperceptible at the wrist. The breath- 
ing is quiet and not attended with a puffing out of the 
cheeks. 

Insensibility from Drink or Narcotic Poisoning. Po- 
licemen and bystanders often mistake a case of Apo- 
plexy for one of profound intoxication. There are a few 
points of distinction which should prevent such mistakes. 
If a person is " dead drunk, " the pulse is soft and rapid 
usually ; if the eye is touched with the finger, an attempt 
is made to close it. There is a very strong odor of 
liquor, but this is not a trustworthy sign, for a person 
might fall in an apoplectic fit after moderate drinking. 
A drunken person will be affected, generally, when strong 
ammonia is held to his nose ; a person in an Apoplectic 
condition will not. In insensibility from drink no 
paralysis is noticed. The same distinctive marks, or 
nearly the same, are found in poisoning from Opium, 
but in the latter case the pupils are contracted to "pin 
holes," if the stage of insensibility is reached. 

Epileptic and Hysterical Coma are generally preceded 
by convulsions ; the stupor is less profound than that of 
Apoplexy. The breathing and the pulse are entirely 
different. 

Treatment of Apoplexy. — Lay the patient down with 
the head slightly raised. If at hand, take a piece of ice, 
fold it in a towel and strike it against some hard object 
till the ice is broken into fine pieces ; then wrap the 
towel around it and apply to the head. If ice cannot be 
obtained, apply the coldest water to be found. This is 



180 HANDBOOK. 

by far the best treatment for Apoplexy, whatever the 
cause may be ; it moderates hemorrhage from a ruptured 
artery, and prevents or allays congestion of the brain. 
In the mean time heat must be applied to the feet and 
legs to draw the blood to the extremities and from the 
head. An injection of soap and water should be given 
to empty the bowels, and if the patient can swallow, give 
a quick cathartic — Castor oil, Salts or Seidlitz powders. 
Do not give stimulants; they increase the amount of 
blood in the brain, and may, on this account, be harm- 
ful. The patient should be kept still. From the writer's 
own experience, and by the authority of others, it may 
be said that there is danger in raising the patient sud- 
denly to a sitting posture, or in laying him down quickly ; 
it is likely to start afresh the hemorrhage. If a clot is 
pressing on the brain, ordinary or extraordinary med- 
icine will not remove it. When medicine is indicated, it 
is generally the Bromide of Potassium or Sodium. It 
lessens the blood pressure in the head. It may be given 
in doses of 20 or 30 grains every 3 hours for awhile. 
Congestion of the Brain. — This means an exces- 
sive amount of blood in the brain. It may be an 
acute and sudden attack. It is often produced by sun- 
stroke, by fits of anger or other excessive mental ex- 
citement, by alcoholic stimulation, etc. If congestion is 
of a sufficient degree, congestive apoplexy may result ; 
but congestion may fall short of this and produce such 
symptoms as intense pain in the head, with a feeling of 
weight, fulness and bursting. Delirium may occur. 



SUDDEN ATTACKS. 181 

The face is flushed and the head hot. The carotids (the 
large arteries in the neck) beat violently. The pulse is 
generally full and strong. A moderate degree of con- 
gestion is not attended with immediate danger. 

Treatment. — This condition plainly calls for cold ap- 
plications to the head, because they drive blood from 
the brain. If at hand, ice-cold water should be used. 
At the same time the feet and legs should be put into a 
hot bath in order to draw the blood from the head to 
the extremities. If the congestion is not rapidly 
relieved by these means, an active cathartic should be 
given, such as a Seidlitz powder or a dose of Salts. 

Fainting Fits (Syncope). — Delicate women and 
those of a sensitive nervous organization are subject to 
Fainting. The attack is sudden and lasts from a few 
seconds to two or three minutes. The patient has at 
first a sensation of sinking at the stomach and about the 
heart. Dizziness, dimness of vision and ringing in the 
ears follow, and the person generally becomes uncon- 
scious. The features look pinched and the lips and face 
are deadly pale. The pulse is at first small and flutter- 
ing, and at last imperceptible at the wrist. The patient 
may not seem to breathe. The first signs of recovery 
are attempts at swallowing, sighing and a return of the 
pulse. The attack terminates with nausea and vomiting 
in some cases. 

The cause of this condition of seeming peril is a tem- 
porary failure in the action of the heart. In nearly all 
cases recovery takes place ; but when fainting is caused 



182 HANDBOOK. 

by great loss of blood there is much danger that it may 
terminate fatally. Persons whose blood is poor and 
watery (anaemic) are subject to Fainting fits. They 
may result from emotions of joy, anger or grief. 

Treatment. — In mild cases the inhalation of a little 
ammonia, eau-de-Cologne, the spirits of camphor or 
sprinkling the face in cold water and fanning, will restore 
to sensibility. In more severe cases the patient must 
be placed in a reclining posture with the head lower 
than the body. If the patient does not breathe, ammo- 
nia will do no good. Dashing cold water in the face 
has a stimulating effect upon the nervous system, and 
through it, upon the action of the heart. In desperate 
cases it may be tried. Heavy flannels wrung out in hot 
water applied over the heart and stomach have a good 
effect. In all cases if the patient can swallow, or as 
soon as he can, the aromatic spirits of ammonia or alco- 
holic spirits are called for. 

Dizziness (Vertigo). — The phenomena of this at- 
tack are, a swimming of the head, a feeling of disordered 
equilibrium, and a condition in which objects seem to 
whirl round the person. If the patient is standing or 
walking, there is often a feeling as if he might fall for- 
ward, and in some cases he does fall, but there is no loss 
of mind. 

Chronic dyspepsia or indigestion is the most common 
cause. The attack is more apt to occur when the 
stomach is empty. It is associated with pain in the 
stomach after eating, heartburn, nausea and vomiting, 



SUDDEN ATTACKS. 183 

flatulency, etc. Occasionally vertigo is a symptom of 
nervous exhaustion. In some cases it depends upon 
disordered vision, causing what surgeons call eye-strain. 
We are assured that dizziness is a prominent symptom 
in diseases of the internal ear. 

Treatment. — But little will be said here in the way of 
treatment. The patient should consult a physician who 
may detect the cause and remove it by treatment 
adapted to the particular case. When the attack comes 
on, the patient should lie down till it passes off. The 
attack in its nature is free from immediate danger to 
life. 

Palpitation of the Heart. — The action of the 
heart may be increased to such an extent that the pa- 
tient has a feeling of discomfort or of actual distress. 
This is called palpitation of the heart. Naturally one 
does not feel the action or beating of the heart. As 
some one said, who was perfectly well, he should not 
know that he had a heart. If the normal movements of 
the heart are much disturbed, the patient will be immedi- 
ately conscious of its existence. Palpitation is very 
common, and is to some persons alarming, especially 
the first attacks. 

The causes of palpitation are many and various. The 
direct cause is an over-excitation of the nerves which are 
connected with the heart. It may be caused by organic 
disease of the heart, but in most cases it is occasioned 
by increased and disordered action and not by real dis- 



184 HANDBOOK. 

ease of this organ. The most obstinate and distressing 
cases the writer has attended were independent of or- 
ganic heart disease. 

Among the predisposing causes are a susceptible and 
excitable temperament ; physical and mental exhaust- 
ion ; the hysterical condition ; excesses of various 
kinds ; poverty of the blood — anaemia. 

Among the exciting causes are violent exercise ; emo- 
tional excitement, such as fright, fear, anger, etc. ; the 
use of strong coffee ; tobacco smoking ; indigestible 
food and dyspepsia. 

The sensations during an attack of palpitation are va- 
ried. There may be a slight nutter or an unnatural 
heavy beating for a brief time, or only momentary. 
Sometimes a single unnatural beat occurs and no more. 
Patients expressing their feelings say that the heart 
" turns over." This sensation often happens during the 
first sleep at night and suddenly awakens the person. It 
may of course occur at other times. 

Besides the slighter disturbances in the action of the 
heart, prolonged paroxysms more commonly happen. 
The heart may beat very strongly and seem to pound 
against the chest-walls ; or, in some cases, it may seem 
to rise into the throat. The beating in some cases is 
very rapid. The sensation is not one of pain, but it is a 
very uncomfortable feeling. The trouble may continue 
for several hours and m&y often return. 

Treatment. — The patient should remain very quiet 
during the attack. The tincture of valerian in one tea- 



SUDDEN ATTACKS. 185 

spoonful doses will in many cases control the trouble. 
The bromide of potassium or sodium, in twenty-five 
grain doses, works well in some instances. Hoffman's 
anodyne in doses of a teaspoonful or more is a good 
medicine for these attacks. It may be taken every fif- 
teen minutes till the patient is relieved. The aromatic 
spirits of ammonia may be tried. Sometimes aromatic 
drinks, essence of peppermint or checkerberry has a 
good effect. If there is organic heart disease, a physi- 
cian will be consulted for remedies to relieve distressing 
palpitation. The causes, if known, such as the use of 
coffee, or intemperate tobacco smoking must be avoided. 
The anaemic, who are particularly subject to these at- 
tacks, are often cured by taking for a while small doses 
of some preparation of iron. 



186 HANDBOOK, 



PAINFUL ATTACKS. 

Headaches. 
Headache makes up a large part of the pain to which 
the human family is subject. It is an attendant upon 
the onset of nearly all acute diseases, and it Often occurs 
independently. We propose to describe here the symp- 
toms, and suggest treatment for several common forms 
of headache, namely : 

1. Sick-headache. 

2. Nervous headache. 

3. Bilious headache. 

1. Sick-headache is known to physicians by other 
names : — Hemicrania, Migraine, and Neuralgie Head- 
ache. The attacks are periodical ; that is, they come on 
with certainty at longer or shorter intervals. The at- 
tacks begin differently in different persons, but in the 
same person the onset is about the same each time. 
Commonly, the person wakes in the morning with a slight 
headache, which gradually increases. Certain excite- 
ment, fatigue, late hours, and late suppers may possibly 
hasten these paroxysms, but they are sure to come 
sooner or later without such exciting causes. They are 
considered by some physicians as a disorder of the 
nervous system, akin to epilepsy and hysteria — nervous 
storms. Many patients have warnings of an attack, 
such as sensations as of a band tightly drawn around 



PAINFUL ATTACKS. 187 

the head, nervousness, irritability of temper, chilly sen- 
sations, uneasy feelings at the stomach, and cold or 
clammy extremities. Another peculiar premonition is a 
disturbance of vision. Spots and fantastic shapes of 
light, and dark colors may dance before the eyes, or 
sharp flashes of light ma} T shoot across the field of vis- 
ion. As the headache increases, these disturbances of 
vision decline, and generally nausea begins, and is soon 
followed by vomiting. The latter symptoms are not al- 
ways present. In some cases, speedy relief comes after 
vomiting ; in more, sleep is required to bring it. The 
pain may be confined to one side of the head. This 
gives it the name of Hemicrania (half of the head). 
Vomiting is rare in this form. The pain may change to 
different parts of the head. It is apt to be severe, and 
located just above the eye. Some persons have de- 
scribed the pain as if "a point in the temple were being 
bored with a gimlet, and the gimlet slowly increasing in 
size." In many cases, the pain is not confined to any 
part of the head. Bright lights and noises increase the 
pain. The ache is often of a throbbing and bursting 
kind, which the slightest movement, mental excitement, 
or effort aggravates. The patient desires to be " let 
alone." The above symptoms do not complete the list ; 
every sufferer could add others to it. The attacks last 
from six to twenty-four hours, or possibly longer. 
Sick-headache ceases altogether at about the age of 
fifty, as a rule. 



188 HANDBOOK. 

Treatment. — This is the important and practical part 
of this matter. It is certainly true that in many in- 
stances these painful attacks may be prevented, or if 
not, they may be mitigated. If the patient has premo- 
nitions, treatment should begin at once. It must be re- 
membered that the remedy which relieves one person 
may not relieve another. A trial of different methods 
and medicines should be made till the appropriate one 
is found. Within the last ten years several new reme- 
dies for headache have come into use. Let the patient, 
as soon as the first intimation is noticed, retire to a quiet 
and darkened room and sleep for a while if possible. If 
the feet and legs are cold, they should be put into a hot 
bath, or hot applications may be made to them. In 
many cases, bathing the head in some cooling lotion acts 
like a charm in allaying the pain. The essence of pep- 
permint, the spirits of chloroform, Pond's extract of 
witch-hazel, alcohol, with a little ammonia added, may 
be used. Cold water is grateful to some ; to a few 
patients hot water applied to the head for awhile is de- 
cidedly better. It may be found that total abstinence 
from food cuts short the threatened attack; in other 
cases, drinking strong coffee or tea, and eating, are fol- 
lowed by effects decidedly better. Let the patient try 
some active physic such as two Seidlitz powders, or a 
full dose of the effervescing Epsom salts in a cup of gin- 
ger tea. 

Try the free inhalation of the spirits of camphor, or 
the water of ammonia cautiously. 



PAINFUL ATTACKS. 189 

If the attack comes on soon after eating a hearty 
meal, a full emetic dose of the syrup of ipecac should be 
taken. 

Freedom from all mental excitement should be se- 
cured in all cases, if possible. 

For neuralgic headaches, in which the pain is located 

in some particular part, the following mixture applied 

on flannels works remarkably well. 

B. Chloroform 

Tincture of Aconite 

Spirits of Peppermint aa ^ ii 

Mix ; shake well before applying ; be careful not to 
get in the eyes ; poison internally. Another new rem- 
edy is a solution of menthol and alcohol, eight drachms 
to one-half pint of alcohol ; bathe the head freely with 
it. 

Coming to internal medicines, we will say that those 
named below may be tried at the beginning or during 
the fully developed attack, but the best effect is obtained 
when they are taken as soon as the pain or the premoni- 
tions are first noticed. 

Guarana, or guarana combined with celery is one of 
the best of the remedies, not known perhaps to every- 
body. All druggists keep it or can obtain it. It is 
free from clanger, and may be taken every half hour till 
the pain is better. 

Often so much nausea is felt that the patient loathes 
anything in the way of medicine ; on this account the 
new effervescing or foaming preparations are the most 



190 HANDBOOK. 

agreeable and the best. They come in the form of 
granules or small grains, which foam when dissolved in 
water. Drinks of this kind sometimes " settle the stom- 
ach " or are better borne than other medicines. 

The citrate of caffeine in granules, two to four grains 
to the close, and taken if need be every hour for a few 
doses, is an excellent remedy, and cures mauy cases. 

The Bromo-caffeine is one of the newer remedies for 
sick-headache. It will cure many cases. It comes in 
the form of granules, and can be bought of any druggist. 
Dose, one to two teaspoonfuls in one-half cup of water, 
to be taken while foaming, and repeated every hour if 
required. 

A still later preparation is the Phospho-caffeine com- 
pound in effervescent granules. It contains a small 
quantity of the new remedy, antipyrin. Dose for an 
adult, one to two heaping teaspoonfuls, and repeated 
every half hour if needed, to be taken in one-half tum- 
bler of water and while foaming. 

The simple bromide of sodium in fifteen to twenty 
grain doses in considerable water should be tried, if it 
never has been. 

The new remedy, Antipyrin, is popular just now, but 
it is too dangerous for everybody to handle, and should 
not be used unless under the direction of a physician. 

Phenacetine is the latest remedy. In some cases it 
has a wonderful effect in curing the headache. It can 
be obtained of druggists in pill form, three grains each. 
They should be cautiously taken. The following medi- 



PAINFUL ATTACKS. 191 

cines can be tried in the intervals of an attack. They 
can be obtained of any druggist. Dr. Wylie, of New 
York City, states that a pill or a capsule containing one 
grain of inspissated ox-gall and one drop of oil of gaul- 
theria, taken every hour as soon as the pain is first felt, 
will almost invariably cure the sick-headache. High 
authorities recommend the alcoholic extract of Canabis 
Indica, made into pills, one-third grain each, to be taken 
three times a day for one or two months. 

A celebrated Philadelphia physician prescribes the fol- 
lowing : 

R. Ammonii Chloridi ^ ss 

Fl. Ex. Cimicifugae ^3 

Grlycerini i ^ ii 

Syrup Tolu 

Aquae Lauro-Cerasi aa ^i 

Mix. Dose, teaspoouful three or four times a day in 
one-half glass of water. 

Nervous Headache. — This is most common in 
women, though it often occurs in men. It resembles 
sick-headache in many points, but its causes are some- 
what different. Mental and physical overwork, worry, 
the want of sleep, and nervous excitement are the fre- 
quent exciting causes. The " sight-seer's headache " is 
a variety of it. A person from the country, who visits 
the city for a day, comes home at night with a bursting 
headache. It is also called the tired headache. Ner- 
vous headache is not always paroxysmal ; it may be a 
steady, but not a severe pain, continuing one, two, or 



192 HANDBOOK. 

several days. Women and children are subject to it. 
It differs from sick-headache in being avoidable and not 
periodical. Disturbances of vision may precede the 
pain, as in sick-headache. Vomiting does not generally 
accompany the attack. The cause of nervous headache 
is usually obvious. These are the principal points of 
distinction. 

Treatment. — If sick-headache is mistaken for nervous 
headache, no great harm will be done in the way of 
treatment, for many of the remedies which are beneficial 
for the one are indicated for the other. Cooling lotions, 
such as were named above, are especially indicated in 
nervous headache. The effervescing granular prepara- 
tions containing the bromides are the best of the class 
of internal remedies, and will generally afford marked 
relief. The bromide of sodium should be tried. The 
aromatic spirits of ammonia is useful in some cases, in 
one-half teaspoonful closes. It is probably true that the 
use of coffee is the cause of headache with some people — 
not with every person. Let the person who suffers of- 
ten with headache leave off drinking coffee for a few 
months and mark the effect ; it will be surprising some- 
times. 

Bilious Headache is the dyspeptic headache. It 
is sympathetic with some derangement of the stomach. 
The word bilious is an old term which sticks to common 
medical language, but it has lost its original meaning, 
for the bile has nothing particular to do with this head- 



PAINFUL ATTACKS. 193 

ache. It is the kind of headache which is the sequel of 
over-eating, or the eating of food which disagrees with 
the stomach, or the intemperate use of stimulating- 
drinks. It is the headache of debauches, banquets, and 
late suppers. The ache may be of great severity, and 
of a bursting or snapping kind. Nausea and vomiting 
sometimes occur, making it appear like sick-headache, 
but the latter symptoms result simply from acute indi- 
gestion. 

D} 7 spepti cs sometimes suffer from a stead} 7 , dull head- 
ache, for days or weeks ; this is usually called a bilious 
headache. 

Treatment. — In these headaches, dependent upon de- 
rangements of the stomach, vomiting often takes place 
spontaneously ; if not, and if there is nausea from undi- 
gested food in the stomach, great relief is sometimes ob- 
tained by the use of some simple emetic, such as large 
drinks of warm water, or warm water with a little mus- 
tard added. If the syrup of ipecac is at hand, two table- 
spoonfuls may be taken, followed by copious drinks of 
warm water. 

If there is no reason to believe that undigested food 
is in the stomach, a mild laxative may be given at once, 
such as Tarrant's Seltzer aperient, Seidlitz powders, or 
the effervescing Epsom salts. Cooling applications to 
the head are grateful. 

Toothache. — An attack of severe toothache makes 
an emergency when the sufferer is far from a dentist or 



194 



HANDBOOK. 



far from having courage to call upon one. The ache is 
a tormenting pain, and whoever has felt it can appreci- 
ate Robert Burns's "views" upon the subject. See 
page 21 in this book. 

The celebrated Dr. Gross, of Philadelphia, said that 
" no domestic remedy for toothache is deserving of any 
attention." He was certainly mistaken on this point. 
The writer of this article, when a boy living in the coun- 
try at a distance from a dentist, often suffered from se- 
vere toothache, caused by exposure to cold and damp- 
ness, until, by means of a simple domestic remedy, ap- 
plied by the ever gentle and loving hands of his mother, 
he was transported from the agonies of that place where 
pain is supposed (by some) to dwell forever to the peace 
of Heaven. After personal experiences of this kind the 
writer discounts anybody's dictum which reduces to 
nothing remedies that are precious to the sufferer when 
nothing better can be obtained. 

When a tooth is ulcerating, domestic remedies will 
not stop the pain. The patient should, as soon as pos- 
sible, visit a dentist, who will either extract the tooth, 
or perform some surgical operation to cure it. But 
there are other and common causes of toothache, 
namely : the exposure of a nerve in a tooth cavity ; an 
inflammation of the membranes around the tooth ; neu- 
ralgia, etc. 

Treatment. — It is sometimes difficult for the patient 
to decide which tooth in particular aches. Take a small 



PAINFUL ATTACKS. 195 

pocket knife and strike each tooth which seems to ache. 
The tooth from which the pain originates will be the 
most sensitive and cause the most pain w r hen struck. 

If a cavity can be found it should be cleared ; then 
take a little ball of cotton, saturate it with either the 
oil of cloves, creasote, or carbolic acid, and pack it into 
the cavity. Sometimes it does as w r ell to wet the cotton 
in a strong and fiery mixture, such as Perry Davis* 
pain killer, tiucture of capsicum (Cayenne pepper) or 
chloroform. 

A wad of cotton as large as the little finger, wet in 
the spirits of camphor and placed between the gum and 
the cheek, will ease the pain sometimes. It may make 
a kind of blister, but this is not so bad as the toothache. 

This remedy sometimes cures : dissolve in one-half 
cup of water two or three teaspoonfuls of common cook- 
ing soda (bicarbonate), hold in the mouth a part of the 
solution for awhile, or until the pain is cured. 

If the pain has been caused by exposure to cold, 
steaming the face should, by all means, be tried. It 
may be done in this way : heat a brick in the fire, then 
drop it into a pail of water, remove it when the sizzling 
has stopped and wrap it up in flannels ; let the patient 
lie clown with the side of the face which aches near the 
brick. The face will be constantly bathed in hot steam ; 
another brick should be heating and a sufficient number 
applied to keep up the steaming operation till the pain 
is relieved ; it may take an hour or more. A large hot 
poultice, or hot steaming flannels applied to the face, 



196 HANDBOOK. 

have about the same good effect, as the curative agent 
is moist heat. In some cases dry heat somewhat re- 
lieves the pain. In connection with the above remedies 
it is best to put the patient to bed, cover him warmly and 
give hot herb drinks, or the tincture of aconite, to pro- 
duce perspiration. 

A Dover's powder, in doses proportionate to the age 9 
is one of the wonderful remedies in connection with the 
steaming. It produces perspiration and relieves pain. 
It should be given with great caution to children. The 
remedy is good whether the toothache is dependent upon 
exposure to cold or upon other causes. 

The ache is sometimes relieved by holding raw whis- 
key or brandy in the mouth. Hot water has the same 
good effect in some cases. 

A wisdom tooth may press so hard upon other teeth 
that it causes constant pain. Extraction is the only 
cure. 

It sometimes happens that neuralgic pain attacks the 
jaw and the teeth. Extraction of a tooth does not cure 
the pain. The steaming operation above described com- 
bined with the use of Dover's powders may be tried ; in 
some cases it brings great relief. 

Earache most frequently occurs in children of a 
delicate constitution. The pain is often very severe 
and hard to bear, and calls for prompt treatment. The 
common causes are exposure to cold and wet ; inflam- 
mation of the internal or of the external passages of the 



PAINFUL ATTACKS. 197 

ear — often resulting in an abscess or " gathering ; " or 
simply neuralgia. The pain from a diseased tooth is 
sometimes felt in the ear. Earache is more likely to 
come on in the evening and is increased when the little 
sufferer lies down in bed. It will be difficult for any 
person except a doctor to make out the precise cause of 
the earache in the first attack ; therefore must be treated 
on general principles. 

Treatment. — Before beginning treatment the teeth 
should be examined carefully. If one is found that is 
very sensitive and decayed it should be removed or 
treated as described above. A surgeon in the City Hos- 
pital, Boston, has recently advised the following treat- 
ment for earache : let the patient lie with the sick ear 
uppermost ; from a teaspoon pour into the ear and fill it 
with hot water, as hot as can be easily borne ; have 
ready and immediately apply to the ear and to the parts 
around it a large hot poultice, preferably of flaxseed 
meal, or if not at hand any good poultice will do well ; 
a hop bag dipped in hot water may be used. As soon 
as the dressings have lost much of their heat they must 
be renewed. The head may be turned over to allow the 
water to run out from the ear. After the dressings are 
taken off, the ear must be plugged with dry cotton, and 
covered with dry flannel. 

"Warm vaseline, cosmoline or sweet oil turned into the 
ear till it is filled, sometimes relieves the pain. A few 
drops of taudanum or of cocaine added to these is an 



198 HANDBOOK. 

improvement of the remedy. Glycerine should never be 
used in an inflamed ear. 

Another remedy, which is in most cases the best of all, 
is a steam bath constantly applied to the ear and over 
the side of the face. This can be applied by means of 
the heated brick in the same way as recommended above 
for toothache. It acts on nearly the same principle as 
the hot water and the poultice treatment above de- 
scribed. 

Some doctors say that filling the ear with warm lauda- 
num will stop the pain. Besides the above remedies 
constitutional treatment may be of advantage. Put the 
child into a hot bath, at least his feet and legs ; give hot 
herb drinks, or small doses of aconite every hour, to pro- 
duce perspiration, which tends to relieve the pain. If 
the pain is very severe a Dover's powder (twelve grains) 
or thirty drops of laudanum may be given to a strong 
middle aged person. 

A warm flannel with a little chloroform dropped upon 
it, held to the ear, will, in some cases, relieve the pain 
for awhile. Tobacco smoke blown into the ear is a fa- 
vorite remedy with some families, and doctors, too. 

In inflammation of the ear there is often a tendency to 
the formation of an abscess, or as it is sometimes called 
a " gathering or rising." The pain cannot be entirely 
stopped till the abscess breaks. The use of poultices 
and hot water hastens the process and allays the pain to 
some extent. 



PAINFUL ATTACKS. 199 

Face-ache, sometimes called facial neuralgia or 
ague in the face, is a neuralgia of the branches of a 
nerve which supplies the face. The pain not uncom- 
monly is of a very severe and twinging kind. It shoots 
in various directions, sometimes into the jaws, into and 
about the eyes, the brow, etc. The ache is apt to be in- 
termittent, that is, not evenly continuous. The old 
name was tic douloureux. Draughts of air upon the 
face, chewing, laughiug or other movements increase the 
pain. 

Treatment. — Moist or dry heat has an excellent effect 
in soothing the irritated nerves. A large steaming 
poultice with a little laudanum poured upon it may be 
tried, or the face may be laid upon a rubber bag filled 
with hot water. 

Pain in the neck. — Muscular rheumatism is the most 
common cause. A " stiff neck" is an example of it in 
its severe form. The characteristic thing about it is, 
that when the neck is at rest very little pain is felt ; but 
when the head is moved, there is a severe catch of pain. 
Fxposure to cold and dampness is the frequent cause. 
There may be attacks of rheumatism of some sets of 
muscles of the neck and shoulders causing more or less 
pain. Neuralgia about the neck sometimes occurs, but 
it is not very common. 

Treatment. — The application of flannels wrung out of 
hot mustard water is good treatment for these attacks, 
if begun early. Flannels saturated in the ammoniated 



200 HANDBOOK. 

liniment are sometimes effective. The affected muscles 
should be kept as still as possible for a few days. 

A mustard plaster kept on till the skin is well 
reddened is often followed by the best results. If the 
pain or discomfort is not great, the affected part may be 
painted twice a day with the tincture of iodine. 



PAINFUL ATTACKS. 201 



PAIN IN THE CHEST. 

In most cases, pain in this region is in the chest walls 
— in the outer shell ; but pain also arises from diseases 
of the lungs and heart. The most common painful 
affections of the chest walls are : Pleurisy, Intercostal 
Neuralgia, Muscular Rheumatism, Spinal Irritation and 
The Shingles. 

Pain arising from diseases of organs in the cavity of 
the chest most commonly is either from Pneumonia, dis- 
orders of the heart, or from Angina Pectoris. These at- 
tacks will be described below in their order. 

Acute Pleurisy is often sudden and without premo- 
nitions. Exceptionally a little soreness and pain is felt 
in the side for a few days before severe pain begins. The 
pain is only a symptom of the real disease. The trouble 
arises on account of inflammation of the pleura, which 
is a membrane lining the lungs and reflected upon the 
inner side of the chest wall forming a closed sack. Ex- 
posure to cold and dampness is commonly supposed to 
be the cause of Pleurisy but it may be produced by in- 
juries of the side, such as blows, falls, fracture of ribs, 
etc. In its less severe form it is common in consump- 
tives, when it is owing to disease of the lungs. The 
stitch-like pain in the side which nearly always accom- 
panies pneumonia is Pleurisy. 



202 HANDBOOK. 

Pleurisy is liable to be mistaken for intercostal neu- 
ralgia, muscular rheumatism of the side and pneumonia. 
The points of distinction will be hereafter given. The 
symptoms of the first stage of Pleurisy will be described. 

The pain begins as a sharp cutting pain in the side, 
especially felt when a deep breath is taken, and when 
the patient coughs. A patient whom the writer attended 
in a sharp attack of Pleurisy declared that he felt that 
u he must cough, and that if he did the pain would kill 
him." The patient bends his body over to one side and 
fixes the chest in a restrained position and makes his 
breathing as short and rapid as possible to prevent the 
pain. 

A chill is often one of the initial symptoms, but chilly 
sensations may take the place of a chill. The patient is 
more or less feverish ; the symptoms are like those of 
other fevers of a mild type. (See page 18 — Symptoms 
and Signs of a Fever.) 

Generally, but not always, Pleurisy is attended with a 
slight cough. The cough is suppressed on account of 
the pain it causes. Attacks of Pleurisy differ widely in 
their severity. In slight attacks the patient may walk 
round out of doors, in other cases he is obliged to take 
his bed. 

Treatment. — In the first stage of this disease the 
object in treatment is to allay the pain and arrest, as 
far as possible, the inflammation. A mustard poultice 
applied to the painful side works wonderfully well in 
many cases. The skin should not be blistered. After 



PAINFUL ATTACKS. 203 



♦ 



the mustard, hot poultices made of flax seed meal are 
called for. They assist iu aiding the pain and inflam- 
mation. Tincture of aconite in doses of three drops 
every three hours is beneficial, for it promotes gentle 
perspiration. If the patient is strong and middle aged, 
ten grains of Dover's powder may be given at the begin- 
ning of the attack. A roller bandage wound tightly 
round the chest affords comfort, because it prevents, to 
some degree, painful motion of the ribs in breathing. 
In severe cases a physician should be called at once. 

Intercostal Neuralgia. — This is a pain in the 
side very much resembling pleurisy and is often and 
easily mistaken for it. It results from an affection of 
the nerves which pass along between the ribs. (The 
word intercostal means between the ribs.) It is like 
neuralgia in other parts of the body, and most com- 
monly occurs in anaemic women, in consumptives, and 
in those who are subject to neuralgia in other parts of 
the body. Unlike pleurisy the attack is not attended 
with fever symptoms. This form of neuralgia is most 
frequent in the left side and between the sixth and ninth 
ribs. The pain may be sharp and cutting or it may be 
burning. When the patient coughs, the catch is not 
usually as severe as it is in pleurisy. The pain is par- 
oxysmal. 

Treatment. — Fortunately, if the case is treated for 
pleurisy, no particular harm will be done. A mustard 
plaster sometimes relieves the pain. Flannels wrung 



204 HANDBOOK. 

out of hot mustard water allay the pain. Ammoniated 
liniment or chloroform liniments have a good effect. 
Dry heat applied in any convenient way may be tried. 
A solution of menthol in alcohol (eight drachms to 
eight ounces of alcohol) is remarkably well adapted to 
relieve neuralgic pain in this situation. The solution 
should be applied on cotton-wool and covered with oiled 
silk. For further treatment, the reader is referred to the 
treatment of neuralgia in another article. 

Muscular Rheumatism is very common in the 
muscles of the chest walls and is liable to be mistaken 
for pleurisy or intercostal neuralgia above described. 
Soreness, lameness, tenderness on pressure, and pain 
when the affected muscles are used, characterize this dis- 
ease. When the muscles are perfectly relaxed not much 
pain is felt ; but a person must breathe and move the 
chest at times ; this occasions more or less pain. A 
single muscle or a set of chest muscles may be affected. 
The short muscles between the ribs may be attacked ; 
then there is pain when the ribs are moved in the act of 
breathing. The pain is not usually so severe as it is in 
pleurisy. Unlike pleurisy, no fever attends muscular 
rheumatism. 

Treatment. — To cure this pain and lameness, doctors 
usually rely upon some counter-irritant, such as a mus- 
tard plaster or the tincture of iodine painted upon the 
skin over the affected muscles. Strong ammoniated lin- 
jnents freely rubbed on have a good effect. The ex- 



PAINFUL ATTACKS, 205 

ternal remedies which have been recommended for in- 
tercostal neuralgia do good in muscular rheumatism. 
Persons who are subject to this kind of rheumatism 
from exposure to cold should wear warm flannels and 
over them a chamois skin jacket. 

The Shingles. — (Herpes Zoster) . This is a kind 
of neuralgia affecting one side of the bod} T , attended 
with an eruption following the course of the painful 
nerve in the side, from the middle line behind to the 
middle line in front. The eruption at first consists of 
groups of water blisters (vesicles) arranged on patches 
of scarlet red and inflamed skin. In older persons the 
affection is very painful ; on this account it is described 
here ; it is usually classed among skin diseases. The 
pain sometimes precedes the eruption ; then it is mis- 
taken for simple neuralgia, but when the humor appears 
the case is unmistakable. The cause of the trouble is 
an inflamed sensory nerve. There are many persons 
who never saw or heard of the Shingles, but others 
have, and have heard that if the eruption girdles the 
body it will be fatal ; this is a mistake. The eruption hardly 
ever does encircle the body. The nerve affected starts 
from the spine and only goes halfway round the body and 
there stops. The disease must and does stop with the 
nerve. 

Treatment. — Apply to the side carbolized cosmoline 
or plain cosmoline and cover it with oiled silk. This is a 
soothing dressing and prevents the inflamed skin from 



206 HANDBOOK. 

being irritated by the clothing. If these are not at 
hand apply any soothing ointment ; mutton- tallow is 
better than nothing. Ointments containing cocaine is 
the new remedy for Shingles, and the relief from its use, 
in some cases, is magical. 

Spinal Irritation. — As a rule, the most serious and 
the incurable diseases of the spine are not attended with 
pain, but there is a peculiar disorder of spinal nerves, 
which is known by the above name, and in which pain 
and tenderness are the principal symptoms. Attacks 
are most common in women from fifteen to twenty-five 
years of age, though men are not exempt. Out of two 
hundred and four recorded cases there were only forty- 
two men patients. The cause of the trouble is an un- 
natural excitability of the sensitive spinal nerves. The 
most frequent situation of the pain is in that part of the 
back between or just below the shoulder blades. In 
rare cases it is located in the neck and sometimes about 
the loins. The pain is first felt after some unusual ex- 
ertion, either physical or mental ; it gradually increases 
till it becomes a sharp, burning, shooting or cutting 
pain hard to bear. Pressure upon the back, especially 
upon certain points of the back bone, greatly increases 
the pain. The patient complains that she cannot rest 
her back against the back of a chair without suffering- 
pain. Movements of the chest generally aggravate the 
pain. The patient soon observes that there is unusual 
weariness and exhaustion on exertion, and finds that she 



PAINFUL ATTACKS. 207 

cannot walk without intolerable pain. The temper is 
apt to become irritable, and a long train of other symp- 
toms accompanies this illness. The skin is often very 
sensitive when the affected part is touched. There may 
be creeping sensations upon it or a sensation of heat or 
burning. Dyspepsia, nausea and vomiting, sleepless- 
ness, dizziness, coldness of the hands and feet are com- 
mon. 

Nervous and hysterical women are predisposed to 
these attacks. Nearly anything which lowers the physi- 
cal or nervous tone may be the exciting cause. 

The course of the disease is extremely fluctuating and 
uncertain. Recovery may take place in a short time or 
the disorder may prove obstinate and chronic. 

Treatment. — For temporary relief to the pain the rem- 
edies which allay neuralgic pain are generally indicated. 
See the treatment of neuralgia. Dry or moist heat is 
often very useful. Painting the spine with the tincture 
of iodine is highly recommended. For a permanent cure, 
rest, a change in habits and surroundings, nerve-tonics, 
such as the syrup of the lrypophosphites containing qui- 
nine, iron and nux vomica are very useful. 

Pain about the Heart. — Not infrequently a dull 
pain, or a disagreeable sensation, not really amounting to 
pain, is felt in the region of the heart in persons suffer- 
ing from dyspepsia, anaemia, nervous prostration or ex- 
haustion. 

Rather a sharp pain just under the left breast, ac- 



208 HANDBOOK. 

companied by palpitation of the heart, is often com- 
plained of by hysterical women. These symptoms are 
generally independent of any real heart disease. 

Persons who have had severe attacks of rheumatic fe- 
ver are subject to pain about the heart, and it is some- 
times complained of during the progress of the fever. 
As a rule, pain about the heart is not a prominent or 
frequent symptom in real heart disease, with one re- 
markable exception, angina pectoris. 

Angina Pectoris is a sudden attack of intense an- 
guish about the heart; it has been called a heart pang. 
Just what the precise cause is, has not been determined 
beyond a doubt. It is supposed by some to be a neu- 
ralgia of the heart. During the paroxysm of pain the 
patient feels as if some invisible hand was violently 
grasping the heart or as if it was being torn in pieces. 
Bu*t the pain is not confined to the heart ; it shoots 
in various directions, to the back, to the neck, and 
nearly always down the left arm. The face is pale ; 
the heart palpitates during the fit ; the breathing may 
be very irregular. But worse than the pain is the sen- 
sation of impending death — and death does often occur 
during these attacks, the heart suddenly stops beating. 
After the first attack, others may be brought on by over- 
exertion, fatigue, exposure to cold, or by mental ex- 
citement. Dr. John Hunter, of London, the most cele- 
brated name among modern surgeons, said : "My life 
is in the hands of any rascal who chooses to annoy and 



PAINFUL ATTACKS. 209 

tease me." And, in fact, after suffering for years from 
angina pectoris, be died during an attack, brought on by 
a fit of anger. 

Pneumonia is not particularly a painful disease, 
unless the pleurisy, which generally in adults attends it, 
makes the attack painful. For a description of pleurisy 
pain see page 201. A slight attack of pneumonia might 
be easily mistaken for pleurisy, but generally speaking, 
the onset of pneumonia is much more severe than that 
of the latter ; it is characterized by a chill, a high fever, 
a full and bounding pulse, headache, great weakness, 
usually a stitch-like pain in the side, rapid breathing, 
considerable pressure for breath, a cough, and often the 
raising of rusty looking matter. 



210 HANDBOOK. 



PAIN IN THE STOMACH. 

Pain in this region is very common and is of every 
conceivable degree. A sense of distress or discomfort 
and a feeling of pressure or fulness hardly amounting 
to pain are too well kuown to need description ; they 
usually result from dyspepsia. There are, however, 
other very painful and most distressing attacks, in 
which the pain seems to be located in the stomach, that 
the average person would not, perhaps, be able to rec- 
ognize ; we therefore describe them for the purpose of 
diagnosis. 

Gastritis, which means an inflammation of the 
stomach, is a very painful attack. It often goes by the 
name of gastric fever, but it is not really a fever, 
though there is more or less fever heat. The following 
are in brief the conspicuous symptoms : pain of a burn- 
ing character in the stomach, shooting thence into the 
chest and increased by taking food ; a painful sense of 
constriction ; the act of inspiration increases the pain so 
that the breathing is sometimes shallow and rapid ; the 
stomach is tender on pressure ; nausea and vomiting are 
urgent and distressing ; the stomach will not tolerate 
water or the blandest drink ; great thirst is always 
present, the patient wanting nothing so much as cold 
water ; the bowels are constipated ; the patient is some- 
what feverish ; great and remarkable weakness is com- 
plained of, and the mind is depressed. A train of 



PAINFUL ATTACKS. 211 

symptoms like this unmistakably point to Gastritis. 
Irritant poisoning produces about the same symptoms, 
and is the only thing that closely resembles it. Until a 
physician arrives, a mustard draught may be applied to 
the pit of the stomach, and the patient allowed to swal- 
low a moderate quantity of pounded ice. 

Gastralgia or neuralgia of the stomach is not un- 
common ; it is a violent paroxysm of pain, sometimes 
linked to a chronic organic disease of the stomach ; in 
other instances it seizes one whose stomach has been 
in good condition ; in other cases it seizes one who has 
been subject to neuralgia in different parts of the body ; 
the pain may be excited by some article of food which dis- 
agrees with the stomach. If there is a predisposition to 
it, exposure to cold and damp, cold drinks or violent 
emotions may bring on an attack. 

The pain varies greatly in intensity in different cases. 
It is described sometimes as a cramp-like pain, again 
as a burning or cutting pain, again as a feeling as if 
" claws were clutching the pit of the stomach." 

Pyrosis is another name for water brash or heart- 
burn ; it may amount to a severe burning pain in the 
stomach, shooting thence into the chest or up the oesoph- 
agus into the throat ; a quantity of watery fluid is 
regurgitated, after which the person feels better. These 
attacks are most common in dyspeptics. Powdered 
chalk, lime-water, soda and the subnitrate of bismuth 
give prompt relief. 



212 HANDBOOK. 

PAIN IN THE BOWELS. 

Intestinal Colic. — By this term is meant a 
inodic and more or less severe griping pain in the bow- 
els, supposed to arise from spasmodic twistings or con- 
strictions of the intestines. The patient bends forward, 
presses on the abdomen and tries various positions to 
get relief. The pain seems to center around the navel. 
Simple colic is rare after middle age, but it very fre- 
quently attacks the young. It is classed among the 
functional diseases because no real organic change takes 
place ; it is simply disordered action. The most com- 
mon exciting causes of colic are indigestible food, or food 
which disagrees with the person, acid or cold drinks, 
eating ice-cream, chilling the skin, stoppage, severe con- 
stipation, and intestinal worms. 

Wind Colic or flatulent colic is produced by a disten- 
tion of the intestines with gas, the result of the decom- 
position of the food in the intestines — intestinal indi- 
gestion. The abdomen seems bloated and drum-like! 
This kind of colic is not usually so severe as other 
kinds ; it is very common in infants. 

Bilious Colic is generally preceded by derangement of 
the stomach, loss of appetite, nausea, a bitter taste in 
the mouth, etc. Besides the colic-pain the patient usu- 
ally vomits, at first the contents of the stomach, after- 
wards bile. The bowels maybe obstinately constipated, 
but in other cases there may be bilious diarrhoea. Nearly 
everv one is familiar with slight attacks of bilious colic 



PAINFUL ATTACKS. 213 

from eating something which disagrees with the stom- 
ach ; in many such cases the pain stops after one or two 
operations of the bowels. 

The severest kind of colic is dry colic — not attended 
with diarrhoea or vomiting. The pain is intense, with 
only short intervals of comparative ease. Pressure upon 
the abdomen somewhat relieves the pain. The skin may 
be cold and clammy, and often the patient has chilly 
sensations. In simple spasmodic colic there is no fever ; 
this is unlike inflammatory diseases of the bowels at- 
tended with pain. 

Lead colic or painter's colic, sometimes called dry 
belly-ache, is caused by lead poisoning. The bowels 
are obstinately constipated and the abdomen is drawn in 
towards the back bone. The intestines are drawn up in 
knots and the pain is very severe. 

Treatment. — The ordinary slight attacks of colic in 
children are generally cured by simple domestic reme- 
dies. A little peppermint, anise, or a few drops of 
paregoric may control the pain. Flannels dipped in hot 
water and applied to the bowels are always useful. 
Sometimes in infants and in children an injection of 
warm soapy water into the lower bowel relieves the pain 
as by magic. To an adult a tablespoonful of paregoric 
may be given every one-half hour. If it can be ob- 
tained, the spirits of chloroform in one-half teaspoonful 
doses every twenty minutes is an excellent remedy. 

If the colic is very severe, laudanum, fifteen or 
twenty drops to a dose, is called for to relieve the intol- 



214 HANDBOOK. 

erable pain. It may be given every half hour till the 
pain begins to yield, then it should be stopped. In bili- 
ous colic, particularly if the bowels are constipated, an 
injection of warm water should certainly be tried at 
once. If this does not bring relief, one or two Seidlitz 
powders or other laxative should be taken, to produce a 
free movement of the bowels. A celebrated Eclectic 
physician thus describes his treatment of colic : " Some 
time ago, during a visit to a patient in the country, I 
was taken with the flatulent colic, caused by error in diet : 
I took half a teaspoonful of capsicum {African cay- 
enne), put it into a tea-cup, added a teaspoonful of su- 
gar, and then poured it nearly full of hot water. After 
standing till it was a little cool, I sipped it all, and in 
one hour my pain was gone." 

Cholera Morbus is mostly a hot weather disease. 
Some exciting cause is, however, required to bring on 
an attack, such as eating uncooked vegetables, unripe 
or decaying fruit ; or taking ice-cold drinks ; or checked 
perspiration may be the cause. The seizure is generally 
rather sudden, and often occurs in the night; it is 
preceded by a feeling of weight and uneasiness at the 
pit of the stomach, and often by rumbling in the bowels 
and slight colicky pains ; these symptoms are soon fol- 
lowed by vomiting and purging, colic, great thirst, and 
often by severe and painful cramps in the legs and in 
the abdominal muscles, which are drawn up in knots. 
The vomiting is very urgent ; at first the contents of the 



PAINFUL ATTACKS. 215 

stomach are ejected, after which bile is thrown up. A 
faint feeling is often complained of. 

Such are the distinguishing signs of a case of Cholera 
Morbus, and if they are conspicuous the case will be un- 
mistakable. The disease is a painful one, but it ends in 
recovery in a few hours as a rule ; it may, however, prove 
fatal in weak subjects. Cases of poisoning from tainted 
meat or fish very much resemble it, and other cases of 
irritant poisoning may be mistaken for it. The descrip- 
tion of poisoning from irritants may be found on page 
145. In simple colic, vomiting and purging are not con- 
spicuous symptoms. 

Some doctors regard cholera morbus as of the nature 
of Asiatic cholera, not of the epidemic kind. Cholera 
infantum is the cholera morbus of infants. 

Treatment. — Domestic remedies are hardly sufficient 
to control the pain and vomiting. A physician should 
be called. If one cannot be obtained, or " till the doc- 
tor comes," the treatment may be as follows : immedi- 
ately after vomiting, drink freely of water as hot as can 
be borne. If the essence of peppermint or Jamaica gin- 
ger is at hand, add a little to the hot water. The medi- 
cines recommended on page 213 for colic may be given in 
cholera morbus. Whatever is given, it should be given 
immediately after vomiting, and if it is vomited at once, 
small doses should be often repeated. The hot applica- 
tions to the abdomen must not be forgotten in this form 
of colic pain. A mustard poultice applied to the pit of 
the stomach is useful in many cases, because it allays 



216 HANDBOOK. 

the irritation of the stomach. Pounded ice, in sufficient 
quantities, will sometimes control the vomiting. 

Stoppage of the bowels may occur suddenly; if so, 
urgent symptoms at once appear — severe pain and vomit- 
ing ; but more commonly stoppage is gradual, and re- 
sults from a gradual over accumulation in the large in- 
testine — the colon — of hardened fecal matter, and chiefly 
in oldish persons and in those whose habits are inactive 
or sedentary. The patient may notice (sometimes he 
does not) that his bowels are more costive than usual : 
he takes some cathartic, but it does not have the de- 
sired effect ; something more active is tried; but the 
bowels remain obstinately costive. In the mean time 
colicky pains are felt, but are not severe. The abdomen 
becomes somewhat distended, but it is not usually very 
sensitive to pressure at first. After a while vomiting 
may begin. A physician is called in and finds that 
there is an over accumulation of fecal matter in the in- 
testine. Sometimes but little pain is noticed, and it is 
not of that severe griping character that is felt in simple 
colic. But stoppage may arise from other causes, such 
as compression of the intestine by tumors ; twisting or 
displacement ; stricture of the canal from morbid 
growths ; in children from the folding of the intestine 
into itself. Stoppage of the bowels is most likely to 
take place in that part of the colon called the ccecum, 
which is situated jnst above the groin in the right side 
of the belly. Fecal matter is ap* to collect here, giving 



PAINFUL ATTACKS. 



217 



rise to more or less pain and tenderness, and after 
awhile to a fulness or to a tumor, which can be easily 
felt. The passage through the intestine is not always 
completely closed, but if the case is neglected, fatal 
results may follow. Another part where clogging is apt 
to take place is in the colon on the left side and lower 
part of the abdomen. The lower bowel, the rectum, 
infrequently becomes clogged with hardened fecal matter. 

In the accompany- 
ing figure, the large 
intestine — the colon 
— is seen in the up- 
per part of the abdo- 
men. The Ccecum, 
which is the head of 
the colon, is low 
down on the right 
side and covered in 
the figure by the 
small intestine. 
The S-shaped and 
lower part of the co- 
lon, where stoppage 
is apt to take place, 
is low down on the 
left side and cov- 
ered by the small 
intestine. One important thing should be remembered: 
powerful physic must not be given in the later stages of 




Fra. 26.— Section of Chest and Abdomen. 



A, Heart. 

B, The Lungs. 

C, Diaphragm. 

D, The Liver. 



E, Gall Bladder. 

F, Stomach. 

G, Small Intestine? 
H, Large Intestine., 



218 HANDBOOK. 

a case appearing like stoppage. Injections of warm, 
soapy water to which glycerine is added are always safe, 
sometimes effective, and should be persistently tried. 
Besides this, the latest practice in treatment is to give 
repeated doses of some saline cathartic, such as Seltzer 
aperient, Carlsbad salts, Hunyardi water, or Seidlitz 
powders, which produce a watery condition of the intes- 
tinal tube, liquify its contents, and tend to move the 
bowels. 

Stoppage sometimes occurs as the result of inflamma- 
tion of the ccecum. In this event pain and tenderness 
begin in the right side of the bowels just above the 
groin, and after awhile a tumor can be felt in this region. 

An inflammation in that apparently useless and out-of- 
the-way corner of the alimentary canal, called the appen- 
dix of the caecum, gives rise to symptoms closely resem- 
bling those of inflammation about the caecum. There is 
a small opening into the appendix through which such 
foreign bodies as cherry stones, the seeds of other fruits, 
hard baked beans or a little hardened fecal matter some- 
times passes and becomes impacted, as there is no outlet 
of this sac. The foreign body may ulcerate through the 
coats of the appendix, or an abscess may form and break 
into the abdominal cavity, giving rise to fatal peritonitis. 
When a trouble of this kind is detected in its early 
stage, modern surgery with swift and skillful hand comes 
to the patient's rescue ; an opening down upon the tumor 
is made, the diseased appendix is removed and the pa- 
tient lives. 



PAINFUL ATTACKS. 219 

It is quite difficult to distinguish between inflamma- 
tion of the caecum and that of the appendix. In the way 
of treatment the best thing that can be said here is 
that all affections in this region should be looked upon 
with suspicion, and skillful assistance should be promptly 
called. 

Inflammation of the Bowels. As used by com- 
mon people this term may mean an inflammation of the 
mucous membrane of the small or of the large intes- 
tine, a disease not uncommon in infancy and early 
childhood, but rare in adults. 

Such attacks are attended with pain, diarrhoea, vomit- 
ing and more or less fever. They are too perilous to be 
left to the management of unskillful hands. 

Peritonitis is often called inflammation of the bowels, 
but is an inflammation of the strong membranous sac 
which invests and contains the bowels. Acute periton- 
itis rarely, if ever, comes on as an idiopathic disease. In 
the majority of cases, it begins as a circumscribed or 
local inflammation which has extended from some in- 
flamed organ or part, such as an inflammation about the 
caecum or its appendix, stoppage of the bowels or stran- 
gulated hernia resulting in inflammation, etc. In women 
it occurs as a result of inflammation of the pelvic organs, 
and often as the sequel of a criminal operation to pro- 
duce premature birth. The signs of beginning local 
peritonitis are pain, great tenderness, fever and chilly 
sensations, and often vomiting and obstinate constipation. 



220 HANDBOOK. 

The disease may possibly remain local and end in 
recovery, but it often ends in general peritonitis, which 
is attended with very great danger to life. In inflam- 
mation of abdominal organs or parts, nothing is better 
for first and common treatment, than the application of 
large flaxseed or slippery elm poultices. They serve to 
allay inflammation. The latest theory in the treatment 
of peritonitis is to give some saline cathartic to produce 
free watery stools. 

Strangulated Hernia. A hernia is, in common 
language, a rupture or breach. It is formed by a coil 
of intestine, or a part of its covering, which j)resses 
out through some breach in the abdominal walls. There 
are several kinds; the most common is the inguinal, 
which appears in the groin. The umbilical is common 
in infants ; it is situated at the navel and is pressed out 
when the child coughs or cries. 

The proper thing to do, as soon as it is known that a 
hernia exists, is to put on and wear a good fitting truss ; 
it often entirely cures the trouble in the young. When 
a truss is not worn, and sometimes when it is, a very 
painful and dangerous accident is liable to happen. 
From various causes, such as violent exertion, the hernia 
may be pushed down and become strangulated or con- 
stricted, so that it cannot be easily returned. 

If a constriction takes place, sufficient to cut off the 
circulation of the »blood and the passage of the natural 
contents of the intestines, the patient's life is at once put 




Samuel D. Gross, m.d., l.l.d. 



A very celebrated Author, and a brilliant Lecturer and 
Operator for many years at Jefferson Medical College, Phila- 
delphia. Author of a System of Surgery, two large vol- 
umes, for a long time an authority in surgery. In 1867 he 
was elected President of the American Medical Association. 



PAINFUL ATTACKS. 221 

in jeopardy. The tumor becomes tense, painful and ten- 
der to the touch, and there is a sense of tightness across 
the belly ; the pain increases and seems like colic pain. 
If this condition of things continues long, vomiting sets 
in. 

Treatment. — What should be done ? Send for a sur- 
geon at once. In the mean time, the patient should lie 
down on his back, with his legs raised, and make gentle 
efforts with his hands to press or coax the tumor back 
into place. It is advisable for the patient, during this 
operation, to take in a deep breath and hold it in as long 
as possible. 

If a few trials of this kind are not successful, pounded 
ice should be applied to the rupture for awhile, and then 
another effort made in the same way to put the hernia 
back. If ice is not at hand, the next best thing is to 
apply heavy flannels wrung out of hot water for awhile. 
These things can be done by any intelligent person and 
in fortunate cases they may be successful. If the patient 
is a child, inverting the body may assist in effecting the 
replacement of a hernia. 

A little hernia at the navel, which is common in 
infants, is easily cured by putting on a bandage with a 
silver half dollar sewed up in it, so that it will constantly 
press upon the hernia, and keep it in until cured. 

It is very important, as soon as. it is known a hernia 
exists, that a truss be put on and worn ; if the trouble is 
not cured entirely, it prevents the hernia from getting 
large and painful. 



222 



HANDBOOK. 



Gall-Stone or Hepatic Colic. The gall-bladder is 
a kind of reservoir for the bile which is secreted from 
the liver. The bile passes out from this sac through 
a duct about three inches long, as large as a goose-quill, 
and which opens into the upper intestine. Now it 
happens that stones (concretions) form in the gall- 
bladder from sediments of the bile; these stones may 
remain in the gall-bladder an indefinite time without 
giving rise to trouble, or they may occasion more or less 
dull pain, but in general their existence is not suspected 
till a stone of considerable size starts on its passage 
through the gall-duct, then pain, more or less intense 
and sudden in its onset, is felt in the region of the liver, 
and, perhaps, runs into the back, up to the right shoul- 
der, or seemingly into the stomach and bowels, or in 
various directions. The pain varies in intensity according 
to the size and roughness of the passing stone ; in some 
cases it is very severe. There may be great tender- 
ness over the liver, and the muscles here tensely drawn. 
If the pain is very intense the patient may go into a 
condition bordering on collapse. 

Vomiting is a prominent symptom, almost constantly 
present ; chilly sensations are often complained of ; not 
much fever is present ; the pulse in some cases is very 
slow; jaundice is very often noticed after a few days, 
and is owing to the swelling and partial occlusion of the 
bile-ducts. 

Frequently the pain begins suddenly and in a shor.t 
time stops as suddenly ; in such cases the stone passes 



PAINFUL ATTACKS. 223 

through the bile-duct, drops into the intestine, and the 
trouble is over. 

The author while visiting a patient who had been sick 
of some slight disorder, was surprised to see him sud- 
denly seized with intense pain in the right side; for 
about three minutes he suffered intense agony ; the pain 
then suddenly stopped and did not return. This was 
undoubtedly a case of gall-stone. About one year before 
the man had an attack of gall-stone colic, which gave 
him great pain for several hours. 

Only a few days ago the writer saw a case in which 
the pain began suddenly, and continued with more or 
less intensity for 36 hours ; it was attended with distress- 
ing nausea and vomiting. For two weeks thereafter the 
patient remained sick and weak, the skin was jaundiced, 
the urine was dark and like saffron-tea in color ; an un- 
comfortable feeling remained in the right side over the 
gall-bladder, with great tenderness on pressure ; this was 
undoubtedly a case of gall-stones, the passage of one or 
more concretions injured and inflamed the gall-ducts. 
Such is the difference in cases. Though such attacks 
are very painful, they are not generally dangerous to life. 
Such cases are apt to be mistaken for simple colic, or for 
"a fit of gravel," and for gastralgia (pain in the stomach). 
When the pam begins suddenly and ends suddenly, the 
case cannot easily be mistaken for anything but renal 
colic, a description of which follows. 

Treatment. — Common domestic remedies have but 
little effect in controlling the pain. Until a physician 



224 HANDBOOK. 

arrives, Hoffman's anodyne may be freely given, or if the 
pain is intense, laudanum, in 30 drop doses every hour, 
till the pain is a little relieved, then omitted. Some 
physicians think that sweet oil in four ounce doses, 
several times a day, is an excellent remedy for gall- 
stones. 

Renal Colic. (A Fit of Gravel.) A calculus, a stone, 
or several of them, not infrequently form in the kidney 
from urinary sediments. They may remain for a long 
time, but commonly they pass down through the ureter, 
which is a small tube leading from the kidney to the 
bladder. If the stone is of small size and smooth, like 
a little gravel, no pain may be felt, and the patient 
may not be aware of its passage ; but if the stone is of 
larger size or rough, most excruciating pain begins sud- 
denly the moment it first enters the fine tube. The 
nature of the attack is similar to that of gall-stone colic. 
The pain is caused by the stone passing through a tube 
too small for its easy exit. When the stone has passed 
through the tube and reached the bladder, intense pain 
stops as suddenly as it begins. The pain is usually felt 
in the loins and shoots along the tract of the ureter to 
the groin, hip or to adjacent organs, or the pain may 
remain fixed at one point. Nausea and vomiting usually 
occur. The fit of pain lasts from a few minutes to 
several hours. It is often mistaken for colic pain. The 
pain greatly differs in different cases as to its intensity. 
In some cases there is an irritation of the urinary pass- 



PAINFUL ATTACKS. 225 

ages and a desire to void the water at snort intervals. 
The urine may and may not contain blood. 

The ailment gets the name of a "fit of gravel" because 
in some cases small gravel-like stones are passed. 

The writer has seen to-day a patient just convalescent 
from an attack of renal colic. The pain began suddenly 
and continued with remissions for nearly a week; the 
pain was located just above the groin, and was so intense 
that morphine was injected to control it. A sore, aching 
and uncomfortable feeling remained for a week or more 
after the acute pain subsided. There was nausea and 
vomiting and obstinate constipation. The urine was not 
bloody and no frequent desire to pass it, as is very often 
the case. No large concretion or stone was found, but 
much gravel or coarse sand. About three years ago the 
same person had the first attack, which began suddenly 
but lasted only one or two hours, and did not return. 
Such is the difference in these attacks. About the only 
thing that can be done is to allay the pain. The im- 
mediate danger in such cases is very little. 

Treatment. — When the pain is unbearable, the same 
anodynes as recommended above for gall-stone colic may 
be taken. For a convenient remedy in allaying the in- 
tense pain no domestic remedy is worth mentioning com- 
pared with heavy flannels wrung out in hot mustard 
water, applied to the side and back; they should be 
changed often and kept hot. Instead of this a hot 
sitz-bath may be tried, the patient sitting in the tub so 
that the water comes up to the waist. This treatment 



226 HANDBOOK. 

will not entirely stop the pain, but somewhat controls it. 

Painful Urinary Disorders. It not infrequently 
happens with oldish men after exposure to cold, and 
after hard work or riding over rough roads, that there 
gets to be pain and difficulty in voiding water; the 
desire to pass water becomes frequent and urgent, but a 
very small quantity is passed at a time, and that with 
much straining and pain ; the urine may accumulate in 
the bladder, and if no relief is obtained, the patient is in 
great discomfort. If the hand is pressed down over the 
region of the bladder, a hard tumor is easily felt after a 
time, which is the distended bladder. In the great ma- 
jority of cases this trouble is caused in oldish men by an 
enlarged prostate gland. No common remedy is of 
much good in the case. A surgeon should be called 
immediately, who will at once relieve the trouble. 

There is another painful affection, resulting from some 
irritation, inflammation, or spasm at the neck of the 
bladder, which is not uncommon. The principal symp- 
toms are a desire to urinate unnaturally often, and the 
act is attended with much pain. The writer has found 
for a common remedy nothing better, or even so effec- 
tive, for immediate relief of the urgent pain as the sitz- 
bath, as hot as can be well borne, continued for some 
little time, and repeated as needed. 

Acute inflammation of the kidneys in oldish persons is 
often caused by exposure to cold and dampness, by the 
rheumatic habit, or by the presence of a calculus (stone) 



PAINFUL ATTACKS. 227 

in the kidney. It usually begins with a chill, followed 
by fever ; the pulse is hard and small ; frequently there 
is nausea and vomiting; the urine is voided drop by 
drop, is red and may contain blood or pus, and when it 
settles from cooling it becomes turbid. 

The patient complains of pain in the back, which may 
be dull, or possibly, sharp and cutting, and aggravated 
by movements. The pain shoots from the kidney in 
various directions. Only one kidney is usually affected. 

The attack lasts from one to three weeks and gener- 
ally ends in recovery. The technical term is pyelitis. 
Such an affection might be mistaken for renal colic or 
"a fit of gravel." A warm sitz-bath or flannels wrung 
out of hot water applied to the back is good treatment. 
It is well to give the patient one drop of the tincture of 
aconite every hour for twelve hours, and produce per- 
spiration. 



228 HANDBOOK. 

MUSCULAR RHEUMATISM. 

A painful affection of the muscles, known to doctors 
by the above name, is very common, and it will not be 
difficult generally for any intelligent person to recognize 
a case of it. The usual exciting cause is an exposure to 
cold and dampness or the over use or strain of a muscle. 
It has been a theory of late that lithic acid in the blood 
is a predisposing cause. 

A distinguished physician thus describes the attack: 
"The development is usually gradual. A dull pain is at 
first felt in certain muscles which increases, and at length 
becomes more or less severe. The pain is comparatively 
slight when the affected muscles are at rest. In certain 
positions the patient may be nearly or quite free from 
suffering, the constant pain which may be felt under 
these circumstances, being of a contusive character, and 
spasmodic pain occurring from time to time; but in 
movements which involve contraction of the affected 
muscles, the pain is severe, cram]) like, and sometimes so 
excruciating that the patient can hardly restrain loud 
groans or cries. 

Voluntary movements which occasion the severe pain 
are avoided as much as possible, but as it is impossible to 
maintain rigidly fixed positions of the body as a whole, 
or of its different parts, the affected muscles are at times 
thrown into painful contraction, however much the pa- 
tient may desire to avoid them. Movements occurring 
during sleep occasion the attacks of pain, and hence, the 
patient is awakened at brief intervals." 

A good example of muscular rheumatism is "a stiff 
neck," or a lame back with a catch in it on movement, 
called lumbago. The muscles of the chest and shoulders 
are quite often attacked. 



PAINFUL ATTACKS. 



229 



Much of the lameness and soreness of the muscles 
which oldish persons feel after unusual work is muscular 
rheumatism. 

The acute form usually lasts from a few days to a 
week or more, the chronic form continues indefinitely. 
The muscles of the neck and shoulder are more com- 
monly attacked in the young ; in older persons those of 
the loins, chest and limbs ; it may attack the scalp and 
give rise to soreness and headache. 

We have described rheumatism of the chest, page 
204, stiff neck, page 199. 

The following table shows the difference in symptoms 
between the disease and neuralgia for which it is often 
mistaken : 

NEURALGIA MUSCULAR RHEUMATISM. 

Pain follows the course of a par- Pain confined to a limited patch 

ticular nerve or its branches. over a particular muscle. 

Oftener attacks the weak and Qften attacks strong persons, 

those of a nervous temperament. M common in men . 
More common m women. 

Movements have but little effect Severely and evidently aggravated 

in increasing the pain. by every movement of the part. 

Severe paroxysms of pain come Pain mostly relieved by keeping 

on when the part is at rest. the muscle at perfect rest. 

Tenderness on pressure limited Local tenderness on pressure over 

to a few points. entire affected muscle. 

Lumbago, or muscular rheumatism of the back, 
is of frequent occurrence. It is sometimes said of a 
person attacked with it that he has "dropped a stitch in 
his back." The patient cannot rise from his chair with- 
out a severe catching pain in his back; he does not 
usually stand straight on account of the pain. Occasion- 



230 HANDBOOK. 

ally it comes on very suddenly while the person is 
stooping. A dull pain is sometimes felt when the per- 
son is quiet, but generally it is only when the muscles of 
the back are used. The appetite and digestion are not 
usually much disturbed and there is not generally fever. 
The trouble continues a week or ten days, or it may be- 
come chronic. A French physician recommends as an 
immediate relief, painting the back with this mixture : 
tincture iodine, collodium, spirits ammonia, each one 
ounce. For other treatment, see that in following pages 
for muscular rheumatism in general. 

Treatment. — Rest of the affected muscle is essential to 
a quick cure. Physicians generally apply some counter 
irritant, such as a mustard draught, ammoniated lini- 
ment, the tincture of iodine, spirits of turpentine, or 
something else which reddens or irritates the skin. 
Moist heat soothes the irritated nerves of the painful 
part. Dry heat, applied in some convenient way, is good 
treatment. Not only theory* but experience, approves of 
the use of saline cathartics at first. 

When the attack is acute and attended with consider- 
able fever and severe pain, it is well to begin treatment 
by taking a Dover's powder at bed time ; it relieves the 
pain, produces free perspiration, and tends to mitigate 
the trouble. The tincture of aconite in one drop doses 
every hour, for awhile, is highly recommended. The 
fluid extract of cimicifuga (black snake root) has the 
credit of curing some cases wonderfully well — dose, one 
teaspoonful every three hours. 



PAINFUL ATTACKS. 231 

Cover the painful part with brown paper and apply a 
hot flat-iron for awhile. Apply powdered sulphur on 
hot flannels covered with oiled-silk or cotton batting. 

For an internal medicine take the following : 

a 

Ammonii chloridi \ oz., extract cimicifuga fluid 2 oz., 
glycerine 1 oz., syrup tolu and the fluid extract of lico- 
rice root of each 1 oz., mix, and take a teaspoonful every 
2 or 3 hours in one-half cup of water. 

Note. To get any prescription found in this book filled, 
take the book to a druggist, and point out to him the one 
desired. 



232 HANDBOOK. 



NEURALGIA. 



This affection in its various forms . is one of the com- 
mon painful disorders of modern times, much more 
common than in the days of our robust progenitors, 
whose nerves were made of stronger stuff, because they 
lived, to a greater extent, out door lives, had better 
digestive powers, breathed purer air in better ventilated 
houses, and became hardened to the vicissitudes of the 
Weather. Neuralgia is conspicuously a disease of the 
weak; some one has said that "neuralgia is a prayer 
of the nerves for better blood." It is true however that 
persons apparently strong, occasionally suffer from neu- 
ralgic pain brought on by exposure. 

Neuralgia is denned as a disorder of the nerves, mani- 
festing itself by pain, which appears to follow accurately 
the course of a particular nerve, or to run into a few, and 
sometimes into all the end branches of the nerve. 

These pains are generally sudden in their onset, and 
are of a cutting, burning, twinging or stabbing kind, 
coming on in paroxysms, to be followed by intervals of 
comparative ease. There is always a tendency for the 
pain to shift from one part to another, so that the com- 
mon saying that "i:>ain which changes round is neural- 
gia," is generally true. No fever heat attends pure neu- 
ralgia; this is one distinguishing mark. Another very 
distinctive thing is that the pain is remittant ; other kinds 
of pain, such as that from inflammation and rheumatism, 
are dull and continuous to a much greater extent, 



PAINFUL ATTACKS. 233 

Frequently neuralgia is periodical, that is, the pain 
comes on at just about the same hour every day ; in such 
cases quinine is by all means the best remedy. 

Neuralgic pains are very uncertain in their duration ; 
they may end in a few hours or days or possibly continue 
for years. A surgical operation, such as cutting or 
stretching the nerve, is sometimes required to effect a 
cure. On page 229 may be found a table showing the 
difference in symptoms between neuralgia and muscular 
rheumatism — a disease which is liable to be mistaken for 
it. 

Space allows only an enumeration of the causes of 
neuralgia. The chief predisposing cause is an inherited 
tendency to nervous diseases. The chief exciting causes 
are anaemia, or impoverishment of the blood, debility, 
great fatigue, exposure to cold and dampness, injury of 
the nerve or pressure upon it, malarial poisoning, inflam- 
mation of the sheath of a nerve, etc. 

The majority of neuralgic patients are women, because 
for one thing, they are much oftener anaemic. Intercostal 
neuralgia is common in women ; it is described on page 
203. Facial neuralgia, another common variety is de- 
scribed on page 199. 

Treatment. — This is the important part of the matter. 
When the nerve from which the pain proceeds is super- 
ficial, external applications of various kinds are known, 
which, to a remarkable degree, allay the pain. Both 
heat and cold have been used with great benefit. Flan- 
nels wrung out of mustard water, as hot as can be borne, 



234 HANDBOOK. 

or hot ])oultices are often used. They should be 
changed often, as the moist heat is the curative agent. 

Dry heat may be applied by means of hot salt or 
sand in bags. Some patients have learned to cure the 
pain by exj)Osing the aching part to a hot fire for a time 
till the i;>ain stops. 

There are several kinds of liniments known to doctors 
which almost certainly relieve the pain ; the following 
are among the best : 

Take chloroform, laudanum, tincture of belladonna 
and essence of peppermint, of each one ounce, mix and 
apply on lint. The mixture is poisonous internally. 

Take tincture of aconite, capsicum and laudanum, of 
each one ounce, mix and add to it three drachms of 
menthol and apply on lint ; poisonous internally. 

A mustard draught sometimes allays the pain. Spirits 
of turpentine applied on flannels may be tried. 

Equal parts of gum camphor and chloral hydrate 
rubbed up till liquified, and applied with a brush, is a 
favorite remedy with some doctors. 

When neuralgia is dependent upon debility or an- 
aemia, as it often is in women, some preparation of iron is 
called for. Di\ Anstic, London's celebrated specialist, 
prefers in such cases the tincture of the chloride of iron in 
20 drop doses ; it may be taken in a little glycerine and 
sugared water after each meal It increases the appetite 
and the digestion and helps to make good blood An 
elixir of the chloride of iron and gentian is not disagree- 
able to the taste, and is an excellent medicine ; it can be 



PAINFUL ATTACKS. 235 

bought of any druggist. Dose two teaspoonfuls after 
meals. 

For all periodical neuralgias, quinine is the remedy 
par excellence ; no other medicine is worthy to be com- 
pared with it in such cases. 

Sciatic Neuralgia belongs to middle and advanced 
life, and is more common in men than in women. The 
predisposing causes of neuralgia in general have little to 
do with developing sciatica. One writer says that it 
ranks next in frequency to intercostal and facial neural- 
gia. The attack is apt to begin during the damp and 
cold months. Probably, exposure and strain are frequent 
causes. 

The pain sometimes begins suddenly ; more commonly 
more or le. s pain is first felt in the back and about the 
hip, and a feeling of weakness in the leg , soon the ])ain 
becomes neuralgic in character, and shoots down the 
outer side of the leg, following the course of the sciatic 
nerve , the pain is often sharp and paroxysmal, at other 
times it is a burning feeling. Sudden movements of the 
limb occasion exacerbations of pain. Numbness and 
spasms of the limb are sometimes felt. 

Patients often complain of a cold feeling in the leg, of 
a sensation as if insects were creeping over the skin. 
Pain is not always severe and the attack may end m re- 
covery in a week or two, or it may continue indefinitely 

Treatment. — A distinguished physician says :"I have al- 
ways employed baths in the form of hot sitz-baths and al- 
ways as an adjuvant to other methods of treatment. The 



236 HANDBOOK. 

water should be as hot as the patient can bear, and the 
bath should last for five or six minutes. They may be 
repeated once or even twice a day ; they are followed by 
a certain amount of relief." 

In many cases of sciatica, the writer has found that dry 
heat has an excellent effect. Two French jjhysicians say 
that they have completely and permanently cured the 
disease by enveloping the limb in a thick coating of sul- 
phur, spread on flannel. For further treatment, see the 
treatment of neuralgia in the preceding article. 

Acute Articular Rheumatism. As this is one of 
the painful affections, we shall briefly describe the 
initial symptoms. When the disease continues a week or 
two, as it generally does, it is called a "rheumatic fever." 
The onset may be quite sudden, or, in a certain number 
of cases, fever with its attendant symptoms precedes the 
pain and swelling of the joints ; but in more cases, fever 
and pain in the joints are simultaneous in beginning. 

Pain, tenderness, heat, swelling and redness of the 
skin attack some joint; the pain is not usually severe 
when the joint is at rest, but the slightest motion excites 
it ; on this account the patient keeps the limb in a fixed 
position as long as possible ; one joint after another may 
be • attacked in quick succession, or the trouble may be 
confined to one joint for a longer time, and then rather 
suddenly leave it to seize another, usually on the opposite 
side of the body. Fever with the so-called fever symp- 
toms always attends severe attacks. 



PAINFUL ATTACKS. 237 

The affection may be sub-acute, that is, mild, and only 
one or two joints affected. Within late years great 
improvement has been made in the treatment of articu- 
lar rheumatism. A physician should be called early. 
This kind of rheumatism is very much more serious and 
requires more skillful treatment than common muscular 
rheumatism, which has been described. A careful study 
of the symptoms and signs of the two diseases will ena- 
ble any person to distinguish one from the other. 

Chronic Rheumatism is a painful affection of the 
joints which 4 runs a chronic course, and exists in all 
grades of severity. It is sometimes a sequel of the acute 
form. The most common predisposing cause is the so- 
called rheumatic diathesis. Debility, and exposure to 
cold and dampness incident to out-door occupations, are 
exciting causes. The chief symptoms are pain and stiff- 
ness of the joints. There is not usually that redness and 
swelling which is noticed in acute rheumatism. 

The pain is of an aching, dragging, wearying kind, 
attended with a sensation of weight in the limb, and is 
worse at night ; the patient can predict by the increase 
of pain the coming of a storm with the accuracy of a 
barometer. Several joints may be attacked in succes- 
sion, or after a time the trouble becomes fixed in one 
joint. 

There is a form called rheumatic arthritis or deformans 
in which, as the disease progresses, the joints become 
greatly deformed. There is a chronic form of muscular 



238 HANDBOOK. 

rheumatism in which the soreness and lameness is in the 
muscles, not in the joints. 

Treatment. — Dry heat, applied in some convenient 
way affords great comfort and marked relief to the pain. 
A liniment composed as follows is very beneficial : 
tincture cayenne, aqua ammonia, spirits turpentine, olive 
oil, each one ounce, laudanum and tincture aconite, each 
one halt ounce. Before applying the liniment the joint 
should be bathed for awhile in hot water; after rub- 
bing the liniment thoroughly into the skin cover it with 
cotton batting or oiled silk. 

For an internal remedy nothing is better than the fol- 
lowing mixture which is used at the New York hospital : 
iodide potassium, salicylate of sodium, each two drams, 
wine of calchicum seeds two fluid drams, and water suffi- 
cient to make four ounces. Mix. Dose, a teaspoonful 
three times a day, taken in water. If there is much 
debility the compound syrup of the hypophosphites will 
be very beneficial. 

An English physician has for four years used as a 
local or external application a liniment made of the oil of 
wintergreen and olive oil, equal parts. His success has 
been remarkable, the pain disappearing in four to six 
hours. Over a hundred patients thus treated have re- 
ceived great benefit, excepting two. 

The liniment is rubbed upon the rheumatic joints, 
and then they are covered with cotton -batting. It is 
said to cure in the chronic as well as in acute rheu- 
matism. 



PAINFUL ATTACKS. 239 

Acute Abscess. An abscess is one of the results 
of local inflammation. Throbbing pain, heat, redness 
and swelling, which are the usual phenomena of inflam- 
mation, are first noticed at some ]3art about to be the 
seat of an abscess. The swelling increases and the 
tissues adjoining become tense and painful. After a few 
days it may be noticed that the skin becomes of a purple 
tinge in the center of the swelling and in time, some 
point becomes soft and "boggy" — a sign that pus (mat- 
ter) has formed within and tends to point. At this stage 
the abscess may be lanced, the pain relieved, and the 
cure hastened. 

If the inflammation is extensive and the abscess large, 
the patient will probably have an inflammatory fever, and 
as suppuration takes place, he will have one or more chills, 
and may sweat profusely. An abscess may come on any 
part of the body without any apparent cause. The 
hands in working people are often the seat of abscesses ; 
the cause in such cases is some injury. 

Treatment. — The application of ice, or ice-cold water 
in the first stages of local inflammation may sometimes 
abort or stop the formation of an abscess, but the usual 
practice is to poultice an abscess till it points. 

A distinguished surgeon writes : " Poultices relax the 
skin, promote perspiration, soothe pain, encourage the 
formation of pus, and expedite its progress to the sur- 
face. They should be large, soft and light, and may be 
made of bread and water, or linseed meal, or chamomile 
flowers boiled till they are soft, or of bran sewed up in 



240 HANDBOOK. 

a flannel bag, which may be dipped in boiling water as 
often as they become cold. If it is desirable that the 
poultice be light, powdered slippery-elm is excellent." 
In many cases laudanum, poured upon the poultice be- 
fore it is applied, improves its anodyne effect. An 
abscess can be opened without pain by applying to the 
skin a little bag containing powdered ice and salt, in 
equal quantities, till the skin is partly frozen and be- 
numbed. 

Felon (Whitlow.) In some of its forms this is an 
extremely painful affection of the fingers or thumb. It 
is a curious fact that it is. more common in women than 
in men. There are two forms : the superficial and the 
deep. 

In the superficial variety the soreness begins immedi- 
ately around or under the nail, at the side of the finger, 
or near the end. The swelling may not be great at first 
but the part is very tender on pressure, and somewhat 
painful. 

In the most superficial variety the inflammation is con- 
fined to the skin or just under it at the side of the nail, 
and is sometimes caused by a slight injury or by some 
poisonous matter. 

A little pus soon collects under the skin and tends to 
come to the surface ; if it is let out, the trouble ends, if 
not, inflammation may extend to deeper parts, or under 
the nail, and painful and tedious trouble result. 

In the second variety inflammation begins in the 



PAINFUL ATTACKS. 241 

deeper tissues of the finger, or extends on account of 
neglect of the first variety. 

When the palm or side of the finger, thumb or any 
part of the hand feels as if a fine, short, sharp splinter 
had entered the skin, and if there is pain, redness and 
swelling without known cause, one may be pretty well 
assured that a form of a whitlow, commonly called a 
felon, is coming. The finger is much swollen, very ten- 
der on pressure and there is throbbing pain. If the 
inflammation is not promptly arrested, matter forms in 
the deep tissues in three or four days. The pus presses 
under the thick skin and tends to point; if the abscess 
is not opened the pus burrows and may find its way to 
the sheath of the tendon or to the bone, producing a 
painful and serious affection. There is considerable 
constitutional disturbance ; the patient is sick and fever- 
ish. In the worst forms the throbbing pain is so great 
that the person is most miserable and robbed of sleep 
and rest at night. This is especially the case if the in- 
flammation begins, as it sometimes does, near the bone or 
in the sheath of a tendon. 

Treatment. — As soon as it is suspected that a felon is 
coming the following means of aborting or stopping it 
may be tried : Take of soft soap and flaxseed or Indian 
meal, equal parts, stir them together and make a poul- 
tice, envelop the finger in it, applying it snugly, renew 
the poultice every four hours. The finger should be 
examined from time to time and if anything looking like 
a superficial fester or blister is seen, it should be pricked 



242 HANDBOOK. 

or cut open with a sharp penknife. This remedy is 
like the popular lye treatment, which is soaking the 
finger for awhile in lye ; it is simple and there is good 
reason for believing that in many cases it arrests the in- 
flammation ; there is, at least, nothing more likely to do 
it. This treatment should begin at the very first signs 
of a felon. 

Should the pain and swelling continue for two or 
three days an abscess is inevitable ; then a large flax- 
seed poultice, or any good poultice, should be applied 
and changed often. As soon as pus collects the felon 
should, by all means, be opened; nothing else will 
relieve the pain, jmt an end to trouble, and prevent a 
destruction of the finger or a part of it. 

Boils, (Furuncles.) The causes of boils are vari- 
ous. It is usually said that they are caused by "bad 
blood." This may be the case in some instances, in 
others it is not; for instance a change of food is some- 
times the cause in persons apparently healthy. Irritation 
of the skin by blisters, strong liniments or poultices is 
occasionally followed by a crop of boils. A boil begins 
as a reddish pimple which may be soon tipped with a lit- 
tle water blister in the center. The pimple increases in 
size and becomes dark red or purple in color ; at the 
same time the pain increases ; it is at first stinging, at 
last a throbbing pain. Generally in about the fifth day 
pus or matter forms, and from the seventh to the ninth 
a core is discharged, leaving a central opening, and the 



PAINFUL ATTACKS. 243 

trouble subsides. This is the typical and regular boil, 
but in many cases the course is different. If the boil is 
deep seated it pursues a longer course. In the smaller 
number of cases the boil does not suppurate, it is then 
called a "blind boil," not usually as painful as the other 
variety. 

A Carbuncle is a large and malignant boil, some- 
times dangerous to life; it indicates constitutional debil- 
ity. Its large size and many openings distinguish it 
from an ordinary boil; it usually appears on the back or 
back of the neck, and is a very painful affection, contin- 
uing for two or three weeks. 

It is claimed by some that the application of ice, or 
the tincture of iodine, stops the boil, if applied on its 
first indications. Flaxseed, slippery-elm or other poul- 
tices with a little laudanum poured upon them should 
be put on to a boil ; they serve to soften the tissues, to 
allay pain and hasten suppuration. A few days' pain 
and suffering may be saved by lancing a boil after apply- 
ing a freezing mixture, made of pounded ice and salt, 
equal parts. If several crops of boils tend to come, the 
syrup of the hypophosphites may be advantageously 
taken. The sulphide of calcium in one-sixth grain 
doses, four times a day, has a great reputation as a pre- 
ventive of boils. 



244 HANDBOOK. 



PART IV. 

SOME COMMON AILMENTS. 

TAKING COLD. 

This paper is epitomized, in part, from a recent mon- 
ograph written by a physician in Bellevue Hospital, 
New York City. 

It is not commonly the case that a cold is contracted 
sinvply by exposing the whole body to a low tempera- 
ture, excepting the exposure continues for a long time. 
A cold is taken when some part of the body not accus-. 
tomed to such treatment, is exposed to a draught of 
cold, moist air. The moderately cool days of Spring 
and Fall, the seasons in which the prevailing condition 
of the atmosphere is one of moisture, are likely to pro- 
duce colds, and particularly when there is a change from 
a dry atmosphere to a cooler and moist one. Riding or 
sitting after exercise sufficient to produce perspiration, 
thus allowing it to become too suddenly checked, is not 
an infrequent cause of a cold. Draughts of cool, moist 
air upon the neck while sitting is a common cause. 
Paradoxical as it may seem, the best "lung protector" 
is a pair of boots with thick soles, impervious to moist- 
ure, for a "cold in the chest" is much more frequently 
caused by getting the feet damp and cold, than t>y 



SOME COMMON AILMENTS. 245 

wearing insufficient clothing about the chest. Living in 

hot rooms, and going out only semi-occasionally into the 

cold moist air, is a frequent cause of colds. 

"Cold is the most common cause of disease in temper- 
ate climates, especially in the changeable climate of this 
country. It can excite disease directly, and can affect 
probably all the organs of the body, causing either dis- 
turbed function or organic mischief. Cold, when severe, 
contracts the vessels ; interferes with the circulation, and 
all vital activity; and in this way may cause death. 
But it is with moderate degrees of cold we have chiefly 
to deal. A momentary exposure to a cold draught is as 
frequent an excitant of disease as general exposure for a 
long time. A cold draught playing on the cheek may 
cause facial paralysis, sore throat, or bronchitis ; that is 
to say, cold applied locally may excite disease in the 
neighborhood of its application or in distant organs. 
It is probable, therefore, that cold may act in several 
ways: (1) it may interfere with circulation; (2) it may 
affect the extremities of nerves and excite disease by 
reflex action ; or (3) it may check secretions of the skin, 
the mucous membrane, etc." 

A cold is not really a mere local inflammation, be- 
cause one rarely contracts a cold without feeling more 
or less general disturbance. Its onset is rarely marked 
by a fully developed chill, but usually there are quite 
well marked chilly sensations, pains in the bones, a feel- 
ing of general weakness, loss of appetite, a dull head- 
ache, perhaps, and other evidences that the whole 
system is affected by it. Furthermore, these symptoms 
usually set in before the local inflammation declares 
itself. 

How shall a cold be aborted when one feels the pre- 
monitions of it ? A convenient, yet effective remedy, is 



246 



HANDBOOK. 



the use of heat, both externally and internally; this 
seems to act by restoring the equilibrium of the circula- 
tion. Hot drinks, such as camomile tea, ginger tea or 
any hot herb drink should be taken in considerable 
amount, the feet and legs heated for a while before the 
fire, or a hot foot-bath may be used. 

The tincture of aconite in doses of one drop every 
half hour for five hours is excellent treatment. A sweat 
taken in some way is an effective means of breaking up 
a cold. In addition to these means we possess two 
remedies which have a notable influence on the general 
circulation which results from a cold ; these are quinine 
and a Dover's powder. 

In connection with the treatment above described, 6 
to 8 grains of quinine and 10 grains of Dover's powder 
should be given to an adult. The quinine probably acts 
as a stimulant to the circulation and the Dover's powder 
tends to produce a warmth of the skin and free per- 
spiration and it certainly has a most remarkable effect 
in breaking up a cold. But some persons are disagree- 
ably affected by the opium in it. Quinine is free from 
these objections, though in large doses it is apt to make 
a buzzing feeling in the ears. Hot lemonade or hot 
cider with a little cayenne pepper added is a favorite 
remedy with some persons in preventing or breaking up 
a cold. If a cold is taken through the day, or an ex- 
posure which would be likely to result in a cold, this 
treatment should, by all means, be begun in the early 
evening. If these measures are undertaken sufficiently 



SOME COMMON AILMENTS. 247 

early and properly carried out the patient will awaken 
in the morning, perhaps after a night's refreshing sleep, 
almost entirely relieved of any evidence of a cold ; if not, 
the threatened attack will be mitigated. If treatment is 
not successful in arresting a cold, or if no attempt is 
made in the right direction, the sequel may be a cold 
in the head (acute nasal catarrh or coryza), a sore throat 
(pharyngitis), hoarseness or loss of voice (laryngitis), 
acute tonsilitis (Quinsy), or bronchitis. These affections 
are described below in their order 

A Cold in the Head. Generally persons do not 
regard a cold in the head of sufficient importance to 
require treatment. The attack is at least very disagree 
able and may continue one or two weeks, and possibly, 
run into a chronic nasal catarrh. By timely treatment 
it can be palliated. The drugs which belong to the 
mint series seem to have a good effect in controlling the 
inflammation. 

The following may be given in the form of a snuff : 

Menthol pulv. 2 grs, bismuth sub. carb. 1 drachm, white 
sugar 1 drachm and a half. Mix. 

There are certain remedies which are very beneficial 

in the form of inhalations. Patients find their use 

agreeable on account of the relief obtained. A popular 

German remedy, known as Hager's, is as follows : 

Carbolic acid 1 oz., strong alcohol 3 oz., caustic am- 
monia 1 oz., distilled water 2 oz. 

This is placed in an open-mouthed bottle and the 

fumes inhaled into the nostrils. The tincture of golden 



248 HANDBOOK. 

seal, with equal parts of warm water, snuffed into the 
nose, is effective in allaying the inflammation and cut- 
ting short the attack. 

Acute Pharyngitis means an ordinary sore throat, 
and consists of a catarrhal inflammation of the mucous 
membrane of this part. Gargles of a weak solution of 
alum, borax, chlorate of potash or tannin are very bene 
ficial. A nice Avay of using the potash is in this pre- 
scription : Chlorate potash 30 grains, pulverized gum 
arabic, white sugar, each | oz. Take a small portion on 
the tongue and allow it to melt in the mouth. In the 
act of swallowing, it is distributed upon the inflamed 
throat. 

Acute Laryngitis means an acute inflammation oi 
the mucous membrane of the larynx. The larynx is the 
upper part of the windpipe and the part in which the 
vocal apparatus is situated ; hoarseness, or loss of voice 
results, if* this part is inflamed ; it may be the only 
symptom, or there may be some soreness and more or 
less cough. In the minds of the common people a cer- 
tain amount of gravity attaches to this loss of voice, but 
if it results from a simple cold, as it ordinarily does, it is 
not of serious significance. In the majority of cases, 
the patient first has a cold in the head or a sore throat, 
but exceptionally inflammation first seizes the larynx. 
The loss of voice or hoarseness may continue one or two 
weeks, and almost invariably ends in recovery. 



SOME COMMON AILMENTS. 249 

Inhalations of medicated vapors or steam is the best 
form of treatment, as the remedy is thus applied directly 
to the inflamed part. A little tar, carbolic acid solution, 
benzoin, eucalyptol or camphor may be used in an inhal- 
er, several times a day. An inhaler can be bought of a 
druggist who will instruct the patient in its use. 



250 HANDBOOK. 



ACUTE TONSILLITIS. 



This distressing affection is most common in persons 
from 15 to 25 years of age, rare in early childhood and 
after 30 years. Many persons seem predisposed to it, 
and suffer from recurring attacks. In a typical case, 
and one of considerable severity, the symptoms are well 
marked and distinctive, so that the diagnosis is made 
out without much difficulty. 

The disease sets in with chilliness, fever, headache, 
pain in the back and limbs, and the patient feels miser- 
ably sick from the first. The pulse is unnaturally full 
and strong; the tongue is soon covered with a thick, 
creamy coat; much phlegm collects in the throat and 
saliva in the mouth; the breath becomes foul; there is 
pain and soreness in the throat from the onset; swal- 
lowing is attended with pain and difficulty; in the later 
stages, liquid food is often forced out through the nose ; 
the patient finds it difficult to open his mouth ; the 
voice is changed, becoming thick, gutteral and nasal, 
and the patient makes a snoring noise during sleep ; the 
glands below the ear are often swollen externally, and 
are tender to the touch; deafness is sometimes com- 
plained of, and pain not uncommonly shoots up into the 
ear on the affected side. On examination of the throat, 
one tonsil, possibly both, will be found of a bright red 
color and greatly swollen, the redness and inflammation 
extend over adjacent parts of the throat, to the uvula 
and soft palate. 



SOME COMMON AILMENTS. 251 

This condition of things continues for four or five 
days, and then the patient gets convalescent, or the case 
may terminate in another way: inflammation may go 
on to suppuration, that is, till an abscess is formed in 
the tonsil. In the latter case, the symptoms are aggra- 
vated, more throbbing pain and much more difficulty in 
swallowing are complained of, till the abscess breaks ov 
is opened and discharges matter, after which rapid 
recovery takes place. It is not an easy thing to tell, 
the first three or four days, whether an abscess will 
form or not. The linger may be introduced into the 
throat and the tonsil examined ; if it is soft and boggy, 
matter is probably collecting. Not infrequently, small 
curdy masses or spots are discovered upon the inflamed 
tonsils. 

Follicular Tonsillitis closely counterfeits diphtheria 
in its general and local as])ect, and is often mistaken for 
it. The patient is seized rather suddenly, as in diph- 
theria, with fever symptoms, and a sore throat upon 
which, on examination, whitish spots are seen. The 
onset is marked usually by decidedly chilly sensations* 
followed by a high fever (103° or 104°) in children; 
pain in the throat may be considerable. The affection 
runs its course in from three to five days or more, and 
spontaneously ends in recovery. Soft, cheesy masses or 
spots, which are easily brushed off, collect upon the 
inflamed tonsils. 

Treatment. An attempt should be made to arrest or 
abort tonsillitis. As a tendency to constipation always 



252 HANDBOOK. 

exists, and for other reasons, a saline cathartic should be 
at first given. A hot foot-bath and plentiful drinks of 
herb teas to produce perspiration, or some other manner 
of taking a sweat, is excellent treatment. If at hand, or 
if the medicine can be obtained, the tincture of aconite in 
two drop doses every hour, to an adult, for five or six 
hours, till the skin is moistened, or till the effect of the 
medicine is noticed, should be taken. Many physicians 
advise that the tincture of belladonna in equal quanti- 
ties be taken in combination with the aconite. It has a 
special effect upon the throat. 

If a person is subject to attacks of tonsillitis, the fol- 
lowing medicine should, by all means, be taken at the 
first intimation of an attack: salicylate of sodium 2 
drachms, water 6 ounces, mix, and take a teaspoonful 
every two hours. Many physicians prescribe a gargle 
of water and common cooking soda (bicarbonate) for its 
\)o wer of arresting the inflammation. The writer has 
seen excellent effects from the following treatment: 
take glycerine 7 drachms, the tincture of iron 6 drachms, 
mix, and add one teaspoonful to one-half cupful of 
water, of which a part should be swallowed, and a part 
used as a gargle every three houi s. 

When it seems probable that an abscess is gathering, 
a large flaxseed poultice should be applied to the neck 

Note. In some cases, great relief is obtained by inhaling 
the vapors from vinegar and water, equal parts. In one case, 
which the writer remembers in particular, it seemed almost 
impossible for the patient to breathe for a few hours before 
the abscess broke ; by the use of the above remedy, his condi- 
tion was greatly improved. 



SOME COMMON AILMENTS. 253 

over the tonsils, and as soon as the abscess is " ripe ", it 
should be broken either by pressing quickly upon it with 
the finger, or by the use of the lancet in the hands of a 
physician. 

There is a form of tonsillitis, called catarrhal, in 
which the inflammation is superficial with no tendency 
to the formation of an abscess. Some young persons 
have chronic enlargement of the tonsils ; they are much 
more subject to acute tonsillitis of the catarrhal variety. 

In case the inflammation results in an abscess of the 
tonsil the disease is often called quinsy. 

To one having little exj:>erience with these distressing 
attacks, it would seem, in the worst cases, that the 
patient was in imminent danger of dying, the difficulty 
of breathing and swallowing are so great, but it is rare 
that a case terminates in this extreme catastrophe. 



254 



HANDBOOK. 



COUGHS AND COLDS. BRONCHITIS. 

Acute Bronchitis means an acute inflammation of 
the mucous or lining membrane of the bronchial tubes. 
In its ordinary form it is one of the most common affec-- 
tions. Its danger to life depends upon the age of the 
patient and the size of the tubes affected. Ordinarily, 
the inflammation is confined to the larger and medium 
sized tubes, but those of smaller, and the smallest size 
may be affected, if so, and if the patient is at either 
extreme of life — an infant or an aged person — the 
disease becomes one of very great danger, and receives 
the name capillary bronchitis or suffocative catarrh. In 
the latter case, the disease generally begins as an ordi- 
nary bronchitis, but the inflammation extends from the 
medium-sized tubes to the smaller ones. 

Acute Bronchitis in oldish persons tends to run into 
the chronic form, sometimes called a winter cough, and 
is a troublesome affection. There is no doubt but that 
the lining membrane of the bronchial tubes takes on a 
"habit" of becoming easily inflamed, after a severe 
attack of bronchitis ; slight exposure thereafter is only 
required to incite another attack. 

Measles and whooping cough are attended with bron- 
chitis ; the chief dangerous complication occurs when 
inflammation extends to the finer tubes. On account of 

Note. The bronchitis of infancy and childhood is de- 
scribed in that part of this book, treating of the diseases of 
children, including capillary bronchitis; the latter affection 
is not nearly so common as the bronchitis of the larger tubes ; 
it is verv rare in a strong adult. 



SOME COMMON AILMENTS. 255 

all these facts, a peculiar importance attaches to cases of 

bronchitis. 

"The habits of life have an important influence in the 
causation of bronchitis. The practice of living in heat- 
ed rooms, especially where gas is largely consumed, and 
of breathing the vitiated atmosphere produced by the 
assemblage of large numbers of persons in apartments, 
is undoubtedly a fertile predisposing, as well as exciting, 
cause of the complaint ; so also is the practice of keep- 
ing children too much within doors on the one hand, or, 
on the other, of exposing them to inclement weather 
when insufficiently clad. Temperament can scarcely be 
considered a predisposing cause, but the state of the gen- 
eral health exercises a powerful influence. A weakly 
constitution, or one weakened by overwork, improper 
food, <fcc, predisposes to bronchitis. Again, certain occu- 
pations are favorable to the development of bronchitis. 
Independently of the fact that living or working in heat- 
ed and confined rooms predisposes to the disease, such oc- 
cupations as lead to the inhalation of irritating particles, 
as those of steel, cotton, &c, give rise to it." 

Bronchitis is usually preceded for a few hours or for 
a day or two by coryza and perhaps by a sore throat 
and hoarseness ; there is pain and soreness behind the 
chest bone, slight oppression of breath, hurried breath- 
ing and a paroxysmal cough. If we add to this chilly 
sensations, moderate fever, and more or less pain in the 
back and limbs, we have the main features of the at- 
tack. The fits of coughing at first bring up a little clear, 
frothy mucus, or the cough may be very dry. As the 
case progresses, the matter raised may be abundant, and 
yellowish or greenish in color, and perhaps streaked with 
blood. The fever soon subsides, but the patient's cough 
may continue a long time, or stop within a week or more. 



256 



HANDBOOK. 



Bronchitis is apt to be mistaken for pneumonia and 
pleurisy, as they are attended with a cough and with 
fever. The folloAving table gives some points of dif- 
ference. 



BRONCHITIS. 



PNEUMONIA. 



PLEURISY. 



Begins with chilly 

sensations. 



Usually begins with a 
cold in "the head, sore 
throat and hoarseness. 

No stitch pain in side, 
but sometimes pain un- 
der chest bone. 

Moderate fever. 

Paroxysms of cough 
always. 

Matter raised at first, 
clear, light, frothy mu- 
cus. 

If one places the ear 
to the back under the 
shoulder blades, noisy 
wheezy, and whistling 
sounds may be heard 
on both sides. 



Usually begins with a 
decided chill. 



No symptoms of this 
kind. 



Stitch pain in side, 
generally. 



High fever. 

Cough not prominent, 
often slight or wanting. 

Matter often is mixed 
with blood, called the 
"rusty sputa." 

No such sounds, fine 
crackling sounds may 
be heard at first over 
some part of lung. 



Begins with chilly 
sensations — possibly, a 
chill. 

No symptoms of this 
kind. 



Stitch pain in side. 



Moderate fever. 

Cough slight or want- 
ing, at first. 

Matter raised scanty 
and light colored. 



No such sounds are 
heard. 



Treatment. The first stage of bronchitis is the "dry 
stage " ; the lining membrane of the tubes is inflamed, 
swollen, and inclined to be dry. Severe paroxysms of 
coughing bring up only a little mucus ; coughing is pain- 
ful and increases the inflammation. The primary object 
of treatment in this stage is to soothe the irritated 
membrane and to produce a watery secretion upon the 
inflamed surface, and prevent the severe cough. A 
simple remedy, and one at the same time of remarkable 
virtue, is the linseed or flaxseed oil. It has a particular 



SOME COMMON AILMENTS. 257 

affinity for the mucous membrane of the bronchi, and 
taken in considerable quantity, it increases mucous se- 
cretions, in other words, it loosens the cough. Flaxseed 
meal, of course, contains the same oil ; on this account, 
flaxseed tea is a popular remedy for a cough. 

Any druggist will make an agreeable cough mixture 
from this formula: Linseed oil 4 ozs, emulsion gum 
arabic 2 ozs., glycerine | oz., lemon juice 2 drachms, 
spirits cinnamon 2 drachms and syrup tolu sufficient to 
make 8 ozs. Mix. Dose, 1 tablespoonful 5 or 6 times a 
day. Two teaspoonfuls of the oil may be taken in a 
little milk 5 or 6 times a day. Infusions of slippery-elm 
bark or gum arabic are good remedies in the first stage. 

If in this stage the skin is hot and dry, it is good prac- 
tice to take remedies which moisten it ; for this purpose 
add to two ounces of syrup of ipecac, 20 drops of tinct- 
ure of aconite and take one teaspoonful every hour for 
awhile, and let the person remain in a warm room or in 
bed. If the cough is hard and dry, an excellent medi- 
cine for the first day or two is the compound syrup of 
wild cherry in doses of two teaspoonfuls every three 
hours. 

A poultice made of three parts flour to one part of 
ground mustard, applied to the chest, is undoubtedly 
beneficial in the first stages. 

The following cough mixtures are among the best 
that can be given after the first day or two. 

Muriate ammonia 2| drachms, fl. ext. licorice and syrup 



258 HANDBOOK. 

ipecac each 2 ounces, syrup wild cherry 1 J, water to make 
6 ounces. Mix. Dose, a teaspoonful in much water 4 
or 5 times a day. 

s 

Syrup squills 2 ounces, syrup ipecac and syrup senega 
each | ounce, spirits chloroform \ ounce, syrup tolu to 
make 6 ounces. Mix. Dose, a teaspoonful 4 or 5 times 
a day. 

The following has gone the rounds in many towns as a 

cure for a severe cough : 

Fl. ext. scutillaria, tinct. opii. camph. each 1 ounce, 
chloroform 1 drachm, syrup tolu 2 ounces. Mix. Take 
a teaspoonful every 3 hours. 

At Bellevue Hospital these cough mixtures are used, 

if after the first or dry stage the cough continues and is 

urgent, the mucus tenacious, scanty and difficult to 

raise : 

Muriate of ammonia and the extract of licorice each 
2 drachms, paregoric 2 drachms, water sufficient to make 
6 ounces. Mix. Dose, one teaspoonful in considerable 
water every 3 hours. 

Potass iodide 3 drachms, tincture tolu and fl. ext. 
wild cherry 1 drachm, simp, syrup 1 ounce, Hoffman's 
anodyne 2 drachms, water 1 ounce. Mix. Dose, 1 tea- 
spoonful in water every 3 hours. 

Carb. ammonia 50 grs., potass iodid, 3 drachms, syrup 
wild cherry and Hoffman's anodyne each 1| ounce. 
Mix. Dose, one teaspoonful every 3 hours. 

Note. Any good druggist will fill these prescriptions. 



SOME COMMON AILMENTS. 259 

At the New York Hospital the following mixtures 
are used : 

Muriate ammonia and chlorate potass each 1 drachm, 
extract licorice J drachm, cinnamon water to make 4 
ounces. Mix. Dose one teaspoonful every 3 hours. 

Ether 3 drachms, tincture hyoscyami, the syrup of 
wild cherry each 1 ounce, syrup tolu 1 ounce, water to 
make 4 ounces. Mix. Dose two teaspoonfuls as re- 
quired. 

Potass iodid 3 drachms, Hoffman's anodyne 1 ounce, 
syrup wild cherry 3 ounces. Mix. Dose, one tea- 
spoonful every 3 hours. 

The following is the renowned Stoke's cough pre- 
scription. Carb. ammonia 32 grs., fl. ex. senega and fl. 
ex. squills each 1 drachm, paregoric 4 drachms, water 4 
drachms, syrup tolu, q. s. to make 6 ounces. Mix. 
Take a teaspoonful every 3 hours if required, to loosen 
and prevent urgent cough. 



260 



HANDBOOK. 



CHRONIC NASAL CATARRH. 



Chronic inflammation or catarrh of the mucous mem- 
brane of the nose is classified into three varieties. (1) 
Simple, (2) Hypertrophic, (3) Atrophic. The first form 
or simple nasal catarrh is a common affection, charac- 
terized by a discharge of mucus or muco-pus, and most 
frequently accompanied by pharyngitis. Causes. Resi- 
dence in damp, changeable, cold localities, causing a 
repetition of the acute form, with a constitutional pre- 
disposition. It usually eventuates, if untreated, in the 
second or hypertrophic form, in which the normal ele- 
ments of the mucous membrane may become perma- 
nently thickened. There is usually an excessive se- 
cretion of very tenacious mucus, with more or less 
narrowing of the nasal passages, thus causing a serious 
obstruction to normal respiration through the nose. The 
third or atrophic form is less common than the preced- 
ing, and is far more serious and less manageable to 
treat ; it may occur as a sequence of the hypertrophic 
form. 

Treatment. In the first, or simple form of chronic 
catarrh early treatment is the most satisfactory, but this 
even to be effective must be treated assiduously and 
persistently. Good hygiene and proper diet are impor- 
tant auxiliaries, both as prophylactic and curative meas- 
ures ; healthy activity of the skin, and proper clothing 
are important to look after. Remedies by the stomach 
are of doubtful efficacy only so far as they remove or 



SOME COMMON AILMENTS. 261 

alleviate predisponent causes. Cod liver oil, and chlor- 
ate of potash, if scrofula is suspected, are useful. 

Local treatment is most important, ana this first con- 
sists of thorough cleansing of the parts before the 
application of the remedy selected. For the mechanical 
accomplishment of the first object many methods and 
instruments have been devised ; probably the best treat- 
ment is with the atomizer or appropriate syringe. If the 
secretions are very hard to remove, the nasal passages 
should be sprayed with an alkaline . and antiseptic solu- 
tion like the following • bi-borate of soda one-half dram, 
Listerine one ounce, water four ounces, to be used with 
atomizer . should the secretions be very abundant, the 
syringe would be more effectual in removing them. 
After having cleansed the passages as recommended, 
treatment may be" continued with astringent or altera- 
tive solutions, such as tannic acid, five grains to the 
ounce of water, or sulpho-carbolate of zinc of same 
strength. In the hypertrophic form, where there is 
much thickening of the mucous membrane, more radical 
measures are required ; the following is used successfully 
in many cases: iodine crystals 4 grains, iodide potas- 
sium 10 grains, iodide of zinc, carbolate of zinc, of each 
15 grains, Listerine 1 ounce, water sufficient for 4 
ounces ; to be used as a spray, with atomizer. In cases 
of much stenosis, or narrowing of nasal passages, surgi- 
cal measures are sometimes advisable. 

In the atrophic form, the prognosis is unfavorable as 
to cure, yet much may be done to remove many of the 



262 



HANDBOOK. 



annoying features of the disease by applying to some 
skillful specialist. 




SOME COMMON AILMENTS. 263 

LA GRIPPE. EPIDEMIC INFLUENZA. 

Influenza in one of its forms closely resembles a severe 
cold, but it is something different. This remarkable dis- 
temper has received various names. Italian physicians 
gave it the name Influenza, the French, La Grippe, the 
Germans, Blitz or Lightning Catarrh. It has also been 
called Epidemic Bronchitis, Epidemic Catarrhal Fever, 
etc. 

The first epidemic of it in this country of which we 
have a clear account occurred in 1647, since which time 
many light outbreaks have been known. One occurred in 
1832. During the latter part of the year 1879, and the 
summer of '80, the disease prevailed to some extent in 
the northern part of the United States and in Canada. 
The writer remembers of attending a few cases in the 
field of his practice in 1879. 

It is a remarkable fact that the disease always travels 
from east to west. 

Nothing of the severest form of ej)idemic influenza 
was ever known in this country till the great epidemic 
of 1890 and '91 struck its inhabitants. The distemper 
originated in Russia about Nov. 1, 1889. By Decem- 
ber 15th the disease had spread over Europe. In some 
way it rapidly crossed the wide Atlantic and arrived here 
about December 20, 1889. Within fifteen days after its 
outbreak in New York city, fully two hundred thou- 
sand persons were attacked. 

Medical men who have studied the subject believe 



264 HANDBOOK. 

that the disease is likely to visit this country in its 
severe form from time to time — that it has become nat- 
uralized here. The disease is probably caused by some 
specific infecting poison or germ. A Chicago physician 
thought he made the discovery that the disease is 
caused by a microbe contained in star-dust. One writer 
says of this discovery : " this striped microbe discovered 
in Chicago is unique and must be a wonderful bug." 

A difference in opinions exists among good authori- 
ties about La Grippe being contagious. If it is a germ 
disease, it would seem more likely that it is contagious. 
The disease has two distinct varieties. 

1st, the nervous, sometimes called the neuralgic form. 

2d, the catarrhal. 

The former is the more common and is attended with 
lesser danger to life. Among the common symptoms 
are these : sudden onset, chilly sensations running down 
the back, fever, dizziness, very severe frontal headache 
and pain in the eye balls, pains in the bones, joints, hips, 
back, soreness of the muscles, and neuralgic pains dart- 
ing through the body. Sometimes there is a high fever 
(103° to 105°.) The tongue is coated and the breath 
foul ; the appetite gone ; constipation, as a rule, exists. 
Very severe frontal headache is an early and character- 
istic feature of the attack. 

A curious thing has been noticed in some cases, name- 
ly : the appearance of a rash upon the skin resembling 
that of scarlet fever. 



SOME COMMON AILMENTS. 265 

The physical and mental prostration which attend 
the attack is remarkable. Uncomplicated cases of this 
form run a short course ; the violence of the attack is 
at an end in two or three days, but the patient 
remains without strength or appetite, and sweats easily 
on slight exertion for a considerable time. This de- 
scription applies to severe cases. Mild cases, in which 
pain is not severe, and the depression not great, occur 
in all epidemics. Instances in which strong adults die 
of this form of La Grippe are rare. 

2d. The catarrhal form, if severe, is attended with 
much more danger. In addition to more or less of the 
symptoms described above, the mucous or lining mem- 
brane of the air-passages, and sometimes that of the 
alimentary canal, becomes inflamed. 

Beginning with chilly sensations, fever and pain, 
there is soon a feeling of fulness or tightness in the 
head, running from the eyes, sneezing, sore throat, 
hoarseness, bronchitis and a cough. The fine bronchial 
tubes may be affected, and result in catarrhal pneu- 
monia. If the mucous membrane of the stomach is 
attacked there is pain, nausea or vomiting ; if that of 
the bowels, colicky pains and, often, diarrhoea result. 

The catarrhal form runs a longer course — from four 
to ten days. Convalescence is slow ; the patient is weak 
and unfit for physical or mental work for a long time ; 
relapses easily occur. An Irishman is said to have 
given this description of the affection, " a disease that 
keeps you sick fifteen days after you get well." 



266 HANDBOOK. 

An attack may prove fatal to the young, or to the 
weak and aged, or to those suffering, at the time, from 
chronic disease, owing to the catarrhal complications — 
capillary bronchitis, pneumonia, or, possibly, to the 
great physical depression which attends the disease. 

Treatment. If the attack is at all severe, and even if it 
is not, the patient's chances are much better if he re- 
mains in bed where the tenrperature is uniform. It is 
well at first to take a laxative of some kind. Castor oil, 
or an emulsion of castor oil, answers the purpose. 

If the pain is severe a pill, composed of 2| grains of 
phenasetine and 2| grains of salol, taken every hour for 
awhile, has a remarkably good effect, and if it can be 
obtained it should be pref erred to all other remedies in 
use, at the present time. 

Quinine is another medicine almost indisj)ensable in 
the treatment of the disease. It may be taken in four 
grain doses, at first, every two or three hours. 

Hoffman's anodyne in one teaspoonful doses, every 
hour at first, is a medicine admirably adajrted to meet 
the indications; it relieves pain and acts as a stimulant. 
Dover's powders, for a strong adult, in doses of ten 
grains, three or four times a day, if the stomach is not 



Note. The writer is assured by physicians of large expe- 
rience in the treatment of the disease that Antifebrin, in 15 
grain doses every hour, for two or three hours if required, is 
one of the very best remedies to control the pain. If none of 
the above remedies can be obtained, a tablespoonful of pare- 
goric or 25 drops of laudanum may be taken by a strong adult 
to moderate the intolerable pain. Antikamnia is one of the 
newest medicines for allaying the pain. 



SOME COMMON AILMENTS.. 267 

irritable, is an excellent remedy, relieving the pain and 
producing perspiration, which is desirable. 

In the catarrhal form, something in addition is re- 
quired. For the cough at first, ordinary cough medi- 
cines are harmful — they are too irritating. Flaxseed 
tea, drank in large quantities, is an admirable cough 
remedy in this disease. If the cough is harsh, dry and 
urgent, a few Dover's powders may be very much need- 
ed to moderate it, or instead, Hoffman's anodyne may be 
taken for this purpose. 

The irritation of the air-passages is best allayed by 
inhaling medicated steam or vapors. The following 
mixture should be obtained : comp. tincture of benzoin, 
glycerine, alcohol, each one ounce ; put the mixture into 
an open-mouthed bottle or inhaler, set it in a dish of 
hot water, and inhale the vapor several times a day. 

The following cough mixture is an excellent one; 
paregoric 1 oz., syrup wild cherry 1 oz., syrup tolu 3 
ozs. Mix. Dose, one teaspoonful every two hours. 
Carbonate of ammonia combined with licorice and wild 
cherry is an excellent cough mixture. During convales- 
cence some tonic is beneficial in improving the appetite 
and restoring the strength. The compound syrup of 
the hypophosphites, the elixir of iron and gentian and 
Maltine are admirably adapted to such cases. 

By a Philadelphia Physician. The late epidemic 
of influenza in Philadelphia was characterized by some 
peculiar features. It did not fall upon the whole popu- 



268 HANDBOOK. 

lation at once, but occurred at first in isolated cases. It 
appeared to spread by contagion. The neuralgic forms 
were most frequent here ; with headaches as the most 
common varieties. The usual symptoms were presented ; 
great prostration, intense pain, debility of mind and 
body, low spirits, loss of appetite, etc. Pneumonia was 
very prevalent. Altogether, I do not believe that the 
type was as severe as elsewhere. I base this opinion on 
my own experience largely. Of my twenty-six cases of 
pneumonia, not one died ; a record that shows, either an 
unusually mild type of the influenza that accompanied, 
or unusually good fortune in treatment. All these, and 
most of my other influenza cases, were treated by the 
Marquis Lanza's pills ; two grains each, of quinine and 
acetanilide, and J- grain cocaine. 

Alcohol I could not use in my cases: it invariably 
did harm, and when people took it as a preventive it 
appeared to induce the attack, opening up the system 
and weakening the powers of resistance. I may add 
that I am not a temperance fanatic, and that this oj)inion 
has been forced upon me by my own observation, con- 
trary to my expectations. A very remarkable feature 
of the epidemic is this: the history of epidemics in 
general, is that after they have passed by, the health of 
the community is exceptionally good ; so that the mor- 
tality rate decreases below the normal ; and at the end 
of two years it is found that no more deaths have 
occurred than for the two preceding years. This is 
held to show that those who die of epidemics are the 



SOME COMMON AILMENTS. 269 

diseased individuals, with kidney, heart, lung or liver 
complaints, who would have died any how within the 
year. This influenza epidemic has not been followed by 
the usual improvements in the general health. On the 
contrary, it has left behind it an increased susceptibility 
to all sorts of catarrhal affections, and a lessened capac- 
ity for resisting noxious influences. Never before have 
I had as many transient epidemics of colds, fee, to treat, 
and never have I had as much difficulty in getting rid of 
them. More than once I have been tempted to believe 
that the influenza itself had returned, so like influenza 
was the state of affairs. The large number of deaths 
from diseases characterized by debility, and from heart- 
failure, shows how persistent is the evil worked by the 
epidemic. 

What is the best way to remove the effects of the 
influenza and restore the individual to his or her normal 
health? This question can only be answered by the 
study of the principles of hygiene, and their application 
to particular cases. Cold salt-bathing, brisk open-air 
exercise, regular habits of eating, drinking, sleeping, the 
avoidance of taking cold, and all unnecessary use of 
alcohol and other indulgencies, are the best general 
directions. Sea-bathing suits many cases; mountain 
air others ; but change of air improves the condition of 
all. 



270 HANDBOOK. 

INDIGESTION. DYSPEPSIA. 

i 

Indigestion in its various forms is one of the most 
common ailments for which physicians are called upon 
to prescribe, and for which patent medicine is taken in 
great abundance. The ill health which arises from it is 
often ascribed to some serious organic disease, which 
does not in reality exist. 

As an extensive treatise upon the subject cannot be 
written out in this limited space, it may be useful to call 
attention to a group of symptoms, and to some condi- 
tions of ill-health which are dependent upon indigestion. 
Perhaps only one or two, perhaps many of these symp- 
toms may be complained of in a given case. 

1 . The tongue is usually furred in cases of indigestion > 
it may be white and creamy, yellow or darker in color '■> 
sometimes the tongue is red and raw-looking. Foul 
breath is a sign of indigestion when not due to other 
causes. A disagreeable taste in the mouth in the morn- 
ing is common. 

2. The appetite may be very poor, capricious, or 
entirely wanting ; on the other hand, it may be unnatur- 
ally good, or even ravenous, the patient eating with great 
relish. 

3. In perfect health we are unconscious of the proc- 
ess of digestion. As a renowned poet once said "he 
never was conscious that he had a stomach till he be- 
came dyspejjtic, when he was too frequently aware of 
it." If the functions of the stomach are much disturbed, 
there is a feeling of discomfort after eating or faintness. 

4. Constipation of the bowels, or in other cases 
looseness, is not an uncommon sequence of poor diges- 
tion. It may depend upon intestinal indigestion. In 
health the digestion of food is finished in the intestinal 
canal. 



SOME COMMON AILMENTS. 271 

5. Flatulence is a collection of wind or gas in the 
stomach or bowels, arising from the fermentation of 
food ; it produces a bloated and uncomfortable feeling ; 
eructations of gas from the stomach are very common. 

6. Vomiting is present in some cases ; sometimes the 
vomited matter is nothing but a slimy mucus. The food 
may be vomited soon after eating, or there may be 
morning vomiting of mucus. 

7. Pain in the stomach from indigestion is felt in all 
grades. of severity, from severe cramp-like or griping 
(mostly in acute indigestion), to the gnawing, burning 
sensation which is more common in chronic dyspepsia. 
Pain comes on immediately after eating, or in some in- 
stances, only when the stomach is empty, and is some- 
times relieved by eating. 

8. Heartburn (Cardialgia) occurs usually after eating 
fatty foods, such as sausages, mince-pies, rich gravies, 
etc. It is a hot, burning or scalding sensation in the 
stomach, frequently attended with the eructation of a 
fluid so acid that it "sets the teeth on edge." It is 
caused by an acid fermentation of the food. 

9. The loss of flesh and strength, when this is not 
manifestly owing to some organic disease, may be attrib- 
uted to imperfect digestion and assimilation of food. 

There are other phenomena which indirectly arise from 
indigestion, that are numerous and interesting, affecting 
distant organs or parts of the body through the nervous 
system. These effects, though well known to physi- 
cians, are little understood by the average person. We 
notice some of the most common. 

1. A sense of languor or heaviness, and disinclination 
to exertion, especially after meals ; pains in the back and 
limbs, of a dull, aching kind, sometimes a numbness ; 
gloomy thoughts, low spirits, morbid fears, anxiety and 
irritability of temper are common. 

2. A dull headache, or instead a feeling of tension 
and pressure in some part of the head. Vertigo (dizzi- 



272 HANDBOOK. 

ness) is not infrequent, and it generally leads the patient 
to think that some serious disease of the brain is impend- 
ing- 

3. Palpitation of the heart, irregular pulse, and more 

or less pain in the region of the heart, are not uncom- 
mon, and are phenomena which alarm the patient. 
These disturbances are produced through an irritation 
of the pneumogastric nerve, which is connected with the 
stomach, lungs and heart. 

4. A physician of the highest authority in the Boston 
Medical and Surgical Journal, says that nervous pros- 
tration or exhaustion, with its long train of nervous symp- 
toms and troubles, may take its origin in chronic indi- 
gestion, the disturbances being reflex or sympathetic. 

5. Insomnia, sleeplessness, sometimes in extreme de- 
grees, is a very common result of indigestion. When, 



Note. Eugene Field, "the sweet singer of Chicago," who 
has suffered from nervous dyspepsia, expresses his views on 
the "Pneumogastric Nerve" in these lines : 
Upon an average, twice a week, 

When anguish clouds my brow, 
My good physician friend I seek 
To know ; what ails me now.' 
He taps me on the back and chest 

And scans my tongue for bile, 
And lays an ear against my vest 

And listens there awhile. 
Then he is ready to admit 
That all he can observe 
Is something wrong inside, to wit : 
My pneumogastric nerve ! 
****** 

This subtle, envious nerve appears 
To be a patient foe — 

It waited nearly forty years 
Its chance to lay me low; 

Then like some withering blast of hell 
It struck this guileless bard, 

And in that evil hour I fell 
Prodigious far and hard. 

Alas ! what things I dearly love- 
Pies, puddings and preserves — 

Are sure to rouse the vengeance of 
All pneumogastric rerves ! " 



SOME COMMON AILMENTS. 273 

after hours of restlessness, sleep is at last attained, it is 
disturbed by frightful dreams and nightmares. Diffi- 
culty in breathing and sighing are sometimes present. 
Specks may float in the field of vision. 

6. The secretion of the kidneys may be changed in 
quantity and color ; sometimes a large amount of almost 
colorless urine is passed, in other cases the water is 
scanty, high colored, and cloudy after cooling, deposit- 
ing brick dust sediment. 

7. Skin diseases, (humors) often appear as the result 
of derangements of the stomach, such humors as eczema 
nettle rash, etc. 

8. Convulsions in children are most frequently pro- 
duced by the presence of undigested or indigestible food 
in the stomach or in the alimentary canal. 

9. Hypochondriasis is a peculiar mental disease in 
which there is great depression of spirits, and a morbid 
anxiety about the health. It is nearly always connected 
with obstinate indigestion, often of the intestinal variety. 

A form of indigestion, not infrequent, is technically 
called atonic dyspepsia. It is incidental to a constitu- 
tional weakness or atony ; the stomach is weak in com- 
mon with all the organs of the body, consequently, 
digestion is weak and imperfect ; it is the kind of 
dyspepsia attending all cases of debility and wasting 
disease ; it is also commonly the indigestion from which 
feeble and aged persons suffer. 



Note. Charles Dickens, in his Christmas Carol, makes old 
Scrooge to possess some knowledge of the effects of indiges- 
tion, when he doubted the presence of Marley, his dead 
partner's ghost, in his room. The v host asked Scrooge why 
he doubted his senses. ' Because," said Scrooge, ; *a little 
thing affects them. A slight disorder of the stomach makes 
them cheats. You may be an undigested bit of beef, a blot 
of mustard, a crumb of cheese, a fragment of underdone 
potato. There's more of gravy than grave about you, what- 
ever you may be.'' 



274 HANDBOOK. 

The leading characteristics of this form are: slight 
degrees of gastric pain and uneasiness, simple deficiency 
of appetite and absence of thirst and fever, a pale, broad 
and flabby tongue. 

There is a disease of the stomach in which the gastric 
membrane is slightly inflamed; the affection is then 
called gastric catarrh. Chronic constipation of the 
bowels is sometimes a cause of indigestion, but often er 
a result of it. Besides these briefly described forms of 
indigestion -there are others. The disease is protean in 
form ; it will therefore be impracticable to give anything 
like full directions for treatment. A physician should 
be consulted who will, after careful examination of the 
particular case, prescribe such treatment as is adapted 
to it. We offer a few suggestions which may, possibly, 
lead to more intelligent treatment than to take patent 
medicines which are poorly suited to cases of indiges- 
tion. 

Over-eating, eating too hastily or at irregular inter- 
vals, or eating food which is too rich or hard to digest, 
the intemperate use of tobacco, alcoholic drinks, strong 
tea and coffee are among the common causes of indiges- 
tion. Avoiding the cause is the best treatment. Many 
persons who lead in-door and sedentary lives get dys- 
peptic ; out- door life and exercise bring about wonder- 
ful cures in such cases. In the way of eating, the whole 
story may be briefly told thus : 

Eat the kinds of food which agree with you, at regu- 
lar intervals, and in moderate quantities. Every person 



SOME COMMON AILMENTS. 275 

ought to know by experience what kinds of food "sit 
the best on his stomach." What is one's meat is anoth- 
er's poison, is true regarding dyspeptics. 

As a general rule, starchy and fatty foods and sugar, 
do not agree with dyspeptics. 

In the common and less severe forms of chronic indi- 
gestion, a class of medicines called by physicians the 
simple bitters are very beneficial. They are by name : 
columbo, gentian, quassia, golden seal, gold thread, etc. 
In prescribing, they are often combined with other 
remedies, such as alkalies, acids, aromatics, rhubarb, 
senna, ginger, etc. They are indicated where the appe- 
tite is poor and the digestion slow from gastric debility. 

These remedies combined in various ways form the 
basis of the majority of prescriptions given by many 
physicians in cases of chronic dyspepsia. In inflamma- 
tory and acute affections of the stomach, they are contra- 
dicted. If constipation exists, it should be cured. See 
subsequent articles on the subject. 

If there is pain, nausea and looseness of the bowels 
after eating, take tincture columbo 6 ounces, paregoric, 
2 ounces, mix ; dose, one teaspoonful in a little sweet- 
ened water before meals. 

If there is a tendency to the formation of gas in the 
bowels take columbo half an ounce, ginger half an 
ounce, senna one dram, add to a pint of boiling water ; 
dose, a wineglassful before meals. 

When the appetite is poor and digestion is slow, take 
the following : 



276 



HANDBOOK. 



Comp. tincture gentian, tincture columbo each 2 
ounces, tincture rhubarb, tincture golden seal each 1 
ounce, the syrup of ginger to make \ pint; dose, two 
teasj)Ooniuls just before meals. 

A French physician of note highly recommends the 
following in flatulent dyspepsia : 

Bismuth subnitrat, magnesia, of each 30 grains, bella- 
donna pulv., zingiberis pulv., of each 2 grains. Divide 
into 10 powders. Dose, one twice daily, in peppermint 
water. 

An excellent remedy, kept by nearly all druggists, is 
sold under the name of the comp. bismuth powder. If 
after eating there is a heavy, full or pressed feeling in 
the stomach, and a sense of discomfort, one-half tea- 
spoonful or more, taken in a little water, has a remark- 
ably good effect. If the supper has been a little too 
rich a few doses of this mixture will be found very 
beneficial. 

Some of the prescriptions containing the simple bit- 
ters, such as quassia and columbo, with a litt'e ginger 
added, are exactly suited to the indigestion of the feeble 
and aged, and to those convalescing from acute diseases. 
In a certain class of cases the mineral acids are needed. 
A form of indigestion in which there are eructations oi 
offensive gas, painful digestion, a sallow skin and de- 
pression of spirits, is best relieved by taking dilute nitro- 
muriatic acid in doses of 12 to 15 drops in \ cupful of 
sugared water just before meals. 



SOME COMMON AILMENTS. 277 

In some forms of indigestion, pepsin, pancreatin, in- 
gluvin may be beneficial. From personal experience 
the writer can say that Maltine has a remarkably cura- 
tive effect in some cases when other remedies fail. For 
the atonic indigestion of the aged, light alcoholic drinks 
in very moderate quantity undoubtedly aid digestion. 

Acute Indigestion, (A Fit of Indigestion, Bilious 
Attack, Embarras Gastrique of the French.) Attacks of 
acute indigestion are very common at all ages. The 
causes are various. Eating when the stomach is not in 
condition to digest food, eating food which is difficult of 
digestion and food in too large quantity, eating stale 
meats or fish and other poisonous or irritating sub- 
stances are among the common causes. 

The symptoms vary greatly in severity in different 
cases. Loss of appetite, a coated tongue, possibly slight 
nausea and vomiting, a little distress at the stomach, 
slight headache and indisposition for a day or two, may 
be all the evidence that there is a temporary disturbance 
of the digestive function. 

But generally there is a much greater disturbance. 
There is at first a feeling of uneasiness, pressure or 
distress at the stomach, and a sensation of great weak- 
ness and general discomfort, disgust for food ; nausea, 
vomiting and pain may soon follow; a sensation of 
faintness and sometimes chilliness are complained of; 
the tongue is coated and the breath may be foul ; frontal 
headache is nearly always present and is often very 



278 HANDBOOK. 

severe, so that the attack not un common ly gets the 
name of sick headache ; distress in the stomach is of 
different degrees of severity, it may be severe and 
cramp-like. If the undigested food is not vomited, it 
passes into the intestines and may cause diarrhoea, grip- 
ing and colicky pains. Not uncommonly there is de- 
pression of spirits, a feeling of weight and pressure 
about the heart, a weak pulse, cold extremities and 
cold perspiration. 

If the patient complains of a bitter taste in the 
mouth, if much bile is vomited, and if the tongue re- 
mains coated with a yellowish fur, and the loss of appe- 
tite continues two or three days, the sickness gets the 
name of a "bilious attack." Bilious is an old name 
which sticks to medical language, but it has lost its 
original meaning. 

It is sometimes difficult to distinguish a case of simple 
acute indigestion from one of real gastritis, which means 
an inflammation of the lining membrane of the stomach. 
In the latter case, there is vomiting, thirst, distress and 
fever. The patient may not be able to retain anything 
on his stomach, not even cold water. If an attack of 
this kind continues severely a week or more, it gets the 

Note. Occasionally the circulatory and nervous systems 
are greatly disturbed; palpitation of the heart, difficulty of 
breathing, dizziness, faintness, and in some persons confusion 
of mind, and a condition simulating congestive apoplexy are 
present, while in young children convulsions may occur. 

The writer saw a few days ago a patient, 65 years of age 
suffering from acute indigestion brought on by an error in diet. 
Very severe headache, delirium, pain and distressing vomiting 
were the prominent symptoms. 



SOME COMMON AILMENTS. 279 

name "gastric fever." Hard drinkers are subject to 
attacks of real gastritis. In cases of irritant poisoning, 
gastritis with its attendant symptoms nearly always re- 
sults. Sucli may be the case after eating decaying 
meats, fish, or other poisonous food. 

Treatment. Should the symptoms of acute indiges- 
tion come on after eating, and there is good reason to 
believe that undigested food is in the stomach, the soon- 
er it is thrown out by the act of vomiting the better. 

Nature is wise in such cases, and often spontaneous 
and free vomiting is set up, which removes the offending 
substances from the stomach. If vomiting does not 
take place, it is well to encourage it by taking copious 
drinks of tepid water, with a little i]3ecac or mustard 
added. Undigested food may remain in the stomach a 
long time, causing pain and trouble, if not removed by 
vomiting. 

Unless it is clearly made out that undigested food or 
other irritating substances are in the stomach, emetics 
should not be given; they would be harmful. Some 
disordered condition of the stomach itself, not depen- 
dent upon anything taken into it, may give rise to 
nearly the same symptoms. Such is the case in so- 
called bilious attacks, in acute gastritis, and in many 
cases in which the cause of the acute affection cannot 
be clearly made out. Many of the symptoms above de- 
scribed, as belonging to acute indigestion, are always 
present. The treatment under these conditions must be 
different. A mustard draught over the pit of the stom- 



280 HANDBOOK. 

ach is sometimes beneficial, and if the bowels are consti- 
pated, injections of warm water and glycerine may be 
used, or a Seidlitz powder may be advantageously 
taken. 

In nearly all acute gastric affections absolute physio- 
logical rest of the stomach is an important part of the 
treatment. When food is taken it should be in liquid 
form, such as milk gruel, or a little milk and lime water. 
In these attacks the digestive power of the stomach is 
gone; if the patient eats, it increases his distress and 
prolongs the trouble. In the acute indigestion due to 
an error in diet, even if the sickness seems severe, con- 
valescence is usually established in a day or two, even 
without medicine, and with abstinence from food. 



SOME COMMON AILMENTS. 281 

CONSTIPATION. 

Constipation is the result of numerous causes, and 
some of these are as diverse as they are numerous. 
The most prolific is perhaps from personal habit, not 
attending promptly and regularly to the calls of nature. 
The human family are so constituted that they require 
different kinds of food. Those people who live upon a 
simple diet, or a diet which has but little change, are 
most subject to constipation. Another cause is that of 
drinking too little water. Certain kinds of food are 
also conducive to this condition. Loss of power of the 
muscular tissues of the bowels may be a cause. 

The consequences of habitual constipation are numer- 
ous : headache, backache, dragging sensation about the 
small of the back, indigestion, eructations of gas, palpi- 
tation of the heart, depression of spirits, ennui, mental 
worry, and particularly, inability to do well mental work 
of any kind. 

The treatment of constipation depends much upon 
the existing cause : first learn why the constipation 
exists. The practice of obeying the calls of nature 
promptly has cured many individuals. Every person 
ought to have at least one stool a day, and the most nat- 
ural time is very soon after the breakfast meal. Many 
cases will be cured, and a great many more will be pre- 
vented, by observing this period with strict regularity. 

Suppositories are now-a-days popular. A convenient, 
simple and effective suppositor may be made of glycer- 



282 



HANDBOOK. 



ine or castile soap ; it should be about two inches long, 
as large as the linger, pointed at one end or cone-shaped, 
and passed into the rectum. 

A very fashionable remedy at the present time is 
the glycerine suppositor, found in every well-equipped 
apothecary shoj). Those made by Park, Da\ T is & Co. 
are very convenient and efficient, one of which may be 
used, every day if need be, in the morning after break- 
fasting. 

Another way of using glycerine, which is quite effect- 
ive, is to saturate a piece of cotton wool the size of an 
acorn with pure glycerine and insert it into the rectum ; 
in a short time a copious evacuation is effected. The 
injection of glycerine, about two teaspoonfuis in a little 
warm water, is useful. 

Having considered thus briefly the local remedies, it 
will now be proper to mention some which are used by 
the stomach. The fashionable one at the present, and 
very efficient, is the elixir of cascara segrada, which I 
prefer prepared in the following manner of which a tea- 
spoonful or more can be taken on retiring : — 

Fluid extract cascara segrada 4 ounces, elixir of licorice 
4 ounces, compound elixir of dandelion, 8 ounces. 

These are to be mixed and let stand a few days, and 
after filtering are ready for use. Dose, 2 teaspoonfuis 
twice a day, increasing the dose as needed. 

Many people find a glass of plain soda from the com- 
mon soda fountain a very efficient drink for constipa- 
tion. The Apollinaris water, which in the cities can be 



SOME COMMON AILMENTS. 283 

obtained at many grocers and at all apothecaries, is a 
very useful drink. One of the best pills for family use 
is sold under the name of Barker's Pills, the formula of 
which was suggested by the late eminent Dr. Fordyce 
Barker, a distinguished practitioner of New York, who 
was a native of Wilton, Maine. The formula is as 
follows : 

Ext. colocynth c 1 scruple, ext. hyoscyamus 15 grs., 
powdered aloes 10 grs., ext. nux vomica 5 grs., podoph- 
yllum, powdered ipecacuanha each 1 gr. 

Mix and divide into twelve pills. One or two, at 
most, of these \ril\s are a sufficient quantity for an adult, 
to produce a pleasant, painless movement. 

Very many other remedies could be mentioned in 
this article, like sulphur, rhubarb, senna, the fresh unfer- 
mented juice of the common apple, the bark of the pop- 
lar tree taken from the root, all of which are efficient 
and well known. 

The Massachusetts General Hospital has these directions in 
regard to keeping the bowels regular, printed for the use of 
patients : 

1. Have a certain time at which to go to the water-closet 
every day ; and go at that hour, even if there is no inclination 
to do so. Do not strain, and do not be in a hurry. 

2. Take water before* breakfast and between meals, a glass 
at a time, either hot or cold, as desired. 

3. Eat laxative foods, such as porridge, gruel, stewed 
prunes, baked or boiled apples, any fruits that sit well on the 
stomach, brown bread, graham bread, and green-colored 
vegetables. 

4. Exercise helps to keep the bowels regular. Also, rub- 
bing the bowels. 

5. Take the laxative daily, just enough to give one move- 
ment of the bowels each day. Be careful to take as little of 
the medicine as will answer this purpose, and gradually 
reduce the dose. 



284 HANDBOOK. 

Diarrhoea. In this article we speak of diarrhoea 
when it constitutes the entire ailment, or at least, the 
most prominent symptom. It is one of the symptoms in 
a great many different diseases, but it is not in such cases 
the disease itself. 

There are, of course, different causes for the acute 
and transient forms of diarrhoea ; among the most com- 
mon causes are unsuitable food, too much food, undi- 
gested food passed into the intestines, intestinal indiges- 
tion, foul secretions, intestinal inflammation, impure 
drinking water, summer heat and chilling the surface of 
the body. 

Of these causes probably the most common is unsuit- 
able food or drink, either as to quality or quantity. 
Diarrhoea is common in the hot months, and is owing to 
some putrefactive changes in food, or to the peculiar in- 
fluence of heat. 

There is a form of diarrhoea in which the stools are 
scanty and slimy ; in such cases, the mucous membrane 
of the rectum or that of the colon is inflamed. Cholera 
morbus is an aggravated kind of diarrhoea, occurring in 
hot weather, with such symptoms as urgent vomiting, 
profuse watery discharges, great pain and thirst. 

Some of the causes of diarrhoea are slight, accidental 

and transient ; the discharges they induce are curative 

in their results. A diarrhoea from irritating food tends 

to cure itself, and instea d of being suppressed, it should 

Note. Diarrhoea is one of the most frequent and impor- 
tant diseases of children; it will be fully treated under the 
heading, Diseases of Children. 



SOME COMMON AILMENTS. 285 

be encouraged by mild cathartics. Unhealthy secretions 
and irritating materials developed in the system are 
often eliminated by free intestinal discharges which it 
would be very unwise to check hastily. 

Treatment. If the diarrhoea is evidently due to im- 
proper food or to an improper quantity, a mild cathartic 
may be the proper thing to take ; it clears the intestinal 
tube of irritating materials and tends to cure. A Seid- 
litz powder or a drink of the citrate of magnesia is well 
adapted to such cases. 

The colicky pains which often attend the trouble are 
well controlled by a few teaspoonfuls of paregoric. But 
in spite of this treatment, and the efforts of Nature to 
cure the diarrhoea by removing the cause, it may con- 
tinue for a week or two, or even much longer, especial- 
ly in hot weather, and when the trouble arises from 
some unhealthy condition of the intestines not directly 
dependent upon anything taken into the stomach. In 
such cases some remedy, combined with great care about 
the diet, may be absolutely required to prevent the ex- 
hausting and continued discharges. In the latter cases 
the following mixture taken for a few days sometimes 
effects a cure : paregoric 1 ounce, sweet tincture of rhu- 
barb 2 ounces, tincture of blackberry root 1 ounce, syrup 
of ginger 1 ounce. Mix, and take 2 teaspoonfuls every 
3 hours as needed. In mild cases paregoric, two or 
three teaspoonfuls for a dose, is sufficient to check the 
diarrhoea. 

Dr. Loomis, a celebrated physician, prescribes this 



286 HANDBOOK. 

mixture in cases of diarrhoea which tend to continue too 
long: 

Laudanum \ ounce, tincture of rhubarb \ ounce, 
compound tincture of catechu 1 ounce, oil of sassafras 
20 drops, tincture of lavender compound to make 4 
ounces, Mix. Dose, one teaspoonful every 4 hours, 
for an adult. 

Acute Dysentery (Bloody Flux). An attack of 
dysentery may begin suddenly and abruptly with the 
characteristic slimy and bloody discharges, but generally 
it begins as an ordinary diarrhoea. More or less of the 
fever symptoms are present, such as chills, thirst, head- 
ache, etc. The distinguishing signs of true dysentery 
are the small, frequent, slimy and bloody discharges, 
abdominal pain, and a painful, straining sensation, called 
tenesmus. 

A sense of pressure or fulness, as of a foreign body 
in the rectum, is nearly always felt. In dysentery there 
is an inflammation of the rectum and the colon just 
above it. The disease, if mild or catarrhal, tends 
towards recovery in two or three days ; in more severe 
cases the trouble continues from one to three weeks. 
As a rule, the affection terminates favorably to life, ex- 
ceptionally, it does not. In some instances it is an 
epidemic disease. Attacks of dysentery mostly occur 
in August and September. , 

Treatment. At first a mild cathartic should be taken 
in order to clear the bowels ; castor oil or one or two 



SOME COMMON AILMENTS. 287 

Seidlitz powders do well. It is excellent treatment to 
throw into the rectum a syringeful of boiled starch to 
which 30 drops of laudanum have been added, if the 
patient is a strong adult. This should be retained, if it 
is not, another syringeful may be used. If much pain 
and frequent discharges continue^ the injections may 
be given every two or three hours till relief is obtained. 
It is advised by high authorities to use frequent injec- 
tions of water as hot as can be borne, by means of a 
fountain or other syringe, for the purpose of rinsing out 
the rectum, and thus allaying irritation and j)ain. The 
patient's chances are much better if he remains quietly 
in bed till he is convalescent. 

Hemorrhage from the Lungs, (Haemoptysis). 
This is alarming to every patient, especially if he has 
never had a previous attack. The bleeding may be 
caused either by a rupture of a blood vessel, by disease 
of the heart, and by other lesions, but is most commonly 
occasioned by some disease of the lungs. It may be 
said here that the hemorrhage, even if profuse, is al- 
most never fatal. The blood comes up into the mouth 
with a little cough, and is expectorated. In hemor- 
rhage from the stomach, the blood is always vomited, 
and is thus distinguished from the former. 

Treatment. The patient should be assured that there 
is no immediate danger to life. He should remain in a 
semi-reclining posture in a cool room. 

The most potent, and at the same time convenient 



288 HANDBOOK. 

remedy, is the application of cold to the upper and front 
part of the chest. Cold, by reflex action, astringes the 
bleeding vessels, and tends to check the hemorrhage. 
Flannels wrung out of very cold or iced water may be 
used, or bags of pounded ice may be applied to the 
chest. The patient«should swallow small pieces of ice. 
At the same time heat should be applied to the extrem- 
ities in order to draw the blood from the chest. A hot 
foot-bath is useful. Let the patient eat a teaspoonful of 
fine salt. Take one-half teasj)oonful of the spirits of 
turpentine every one-half hour for awhile. 

Nosebleed (Epistaxis). The mucous or lining mem- 
brane of the nose is very vascular, that is, it is rich- 
ly supplied with a net work of small blood vessels from 
which bleeding is easily excited. In most cases nose 
bleed is of small importance ; in some cases it is salu- 
tary ; excej:>tionally it may be dangerous, or even fatal. 

Usually, and fortunately, the bleeding is from the 
lower part of the nostril. Spontaneous bleeding from 
the nose is most common in young persons of a delicate 
constitution. In declining life obstinate nosebleed 
should be looked upon with some anxiety. 

Treatment. See that the patient sits upright, for 
leaning forward increases the bleeding. Take two tow- 
els and wring them out of ice-cold water, wrap one 
around the neck ; after folding the other, apjjly it to the 
nose and forehead. 

In some cases elevating the arm of the bleeding side 



SOME COMMON" AILMENTS. 289 

high above the head stops the bleeding at once ; it is 
so simple it should always be tried. If these means do 
not arrest the bleeding, add to a cup of water one tea- 
spoonful of powdered alum, and either snuff the solution 
up into the bleeding nostril or inject it up with a 
small syringe. A small roll of cotton cloth, twisted up 
so that it is firm, saturated with vinegar and pressed up 
into the nostril, will generally stop the bleeding. 

Another simple remedy is a piece of salt pork or ham, 
nearly as long as the little finger and about as large, 
pushed up into the bleeding nostril ; it presses upon the 
bleeding vessels, clots the blood and arrests the hemor- 
rhage. 

The writer has in several instances instantly stopped 
profuse hemorrhage from the nose by seizing the pa- 
tient's nose with the thumb and finger, and pressing the 
nostrils together against the bone of the nose ; this 
presses upon the bleeding vessels and clots the blood. 

Powdered Matico is one of the best styptics; it can 
be bought of any druggist ; dust it upon a pledget of 
cotton, and push it up into the nostril as far as the 
bleeding point. 

Take a piece of salt pork large enough to nearly fill 
the nostril, tie a string around it, and with a little probe 
or button-hook, push the plug up so far beyond the 
bleeding part that the blood continues to run out the 
front of the nose, then draw it down with the string 
until it covers and presses upon the bleeding point ; by 
this means the blood is clotted and the bleeding stopped. 



290 HANDBOOK. 

In a paper read before the Illinois State Medical So- 
ciety, it was stated that " ordinary chewing gum, rapidly 
chewed for a few minutes will relieve almost every case 
of epistaxis. " 

Asthma is an affection characterized by paroxysms 
of difficult breathing, recurring at longer or shorter in- 
tervals, often in the night. The immediate cause of 
asthma is a spasmodic contraction of the muscular fibers 
surrounding the bronchial or breathing tubes producing 
a narrowing of their caliber. 

Two principal varieties are recognized: (1) the dry 
or spasmodic, (2) the moist or bronchial. 

In the former whatever cough there may be is dry ; 
paroxysms of labored breathing come on at any time 
without obvious causes, at other times from inhaling 
dust or vapors ; it is purely a spasmodic, nervous disease, 
akin to ej)ilepsy, hysteria, etc. 

In the latter, or moist asthma, the attack seems to be 
induced by bronchitis resulting from a cold, or other 
causes. But it is said that in the majority of cases of 
so-called spasmodic asthma, bronchitis in some degree 
exists, — an important thing only as regards treatment. 
Some faulty condition of the stomach, through reflex 
action, is the exciting cause of an attack in some per- 
sons. The law which governs the causes of spasmodic 
asthma is wonderfully capricious ; for instance a person 
subject to the paroxysms while living in one neighbor- 
hood may be quite free in another near by. The disease 



SOME COMMON AILMENTS. 291 

follows the same caprice as regards the effect of dust 
and vapors. It may be said here that although parox- 
ysms of asthma are often terribly severe, and the pa- 
tient seems to himself and to others in imminent danger 
of dying for want of breath, cases are rare in the ex- 
treme in which they prove the immediate cause of 
death. 

Treatment. To prevent a threatened paroxysm or to 
relieve it when developed, there is no simple remedy 
so effective as the following: Take of stramonium 
leaves, 4 ounces, green tea dust 4 ounces, lobelia \\ 
ounces mix together and wet up with a saturated solu- 
tion of saltpetre ; dry thoroughly, and keep in a close 
can or well-stopped bottle. Burn a little of this, and 
inhale the smoke when suffering. 

Pastills, principally composed of stramonium leaves 
and saltpetre, are sold by druggists. In some instances 
relief is obtained by drinking a cup of strong coffee. 
The compound Spirits of Ether in doses of one teaspoon- 
ful every half hour for awhile, in some cases, affords 
marked relief. In those terrible attacks in which it 
seems that every breath is the last, the inhalation of a 
little Chloroform relieves as by magic, but it is not safe 
unless under the observation of a physician. These 
remedies are simply palliative, but they are precious to 
the sufferer. 

There are medicines which in certain cases are radical 
cures, that is, permanent benefit, with considerable cer- 
tainty, follows their use, especially in so called moist 



292 HANDBOOK. 

asthma. The Iodide of Potassium, or other prepara- 
tions containing Iodine, decidedly stand at the head of 
the list. 

We suggest the following mixtures, which it is be- 
lieved will he found of great value in asthma. One 
thing should be impressed upon the mind, the remedy- 
needs to be taken, in some cases, for several weeks to 
insure its best result, not in all cases. 

Iodide potassium 1 ounce, syrup wild cherry 4 ounces, 
fl. ext. licorice | ounce, tincture columbo 4 ounces, elixir 
calisaya q. s. to make 12 ounces. Mix. Dose, one tea- 
spoonful in a little water after meals. 

Syrup hydriodic acid (Wyeth's) 8 ounces, fl. ext. lic- 
orice | ounce, water q. s. to make 12 ounces. Mix. 
Dose, 1 tablespoonful after eating 3 times a day. 

Iodide potassium 1J drachms, Fowler's solution 1 
drachm, compound spts. ether 2 J ounces, tincture bella- 
donna 2 drachms, syrup of orange peel q. s. to make 6 
ounces. Mix. Dose, 2 teaspoonfuls in a little water 
after meals 3 times a day. 

If bronchitis co-exists, if cough is urgent and the 
phlegm tenacious and hard to raise, the following mix- 
ture is very beneficial in conjunction with the above 
remedies : 

Linseed oil 3 ounces, gum arabic 1| ounces, water 2 
ounces, glycerine and simple syrup, each 1 ounce. Make 
an emulsion and add 1 drachm of the oil of checker- 
berry. Dose, a tablespoonful 3 times a day. 



SOME COMMON AILMENTS. 293 

The following are Hospital Mixtures : 

Sulphate codeine 8 grs., iodide potassium 64 grs., pu- 
rified chloroform 150 drops, simple syrup 6 ounces, 
emulsion of gum arabic q. s. to make 10 ounces. Dis- 
solve and mix. Dose, 1 teaspoonful 3 times a day after 
meals. 

Iodide of ammonium 2 drachms, bromide of ammoni- 
um 3 drachms, syrup tolu 2 ounces, tincture lobelia 5 
ounces. Dissolve and mix. Dose, a teaspoonful in a 
little water three times a day. 

Anaemia (Poor Blood.) So many persons are in the 
habit of taking patent or other medicines to improve or 
purify the blood, that it would be well to understand 
better what symptoms and signs point to the fact that 
the blood is poor, and needs " doctoring ". 

The idea that many persons have that they should 
take medicine to purify the blood is mostly a delusion. 
In the great majority of cases such patients are suffering 
either from chronic indigestion, or from anaemia, or both. 
Many girls and women become anaemic without obvious 
causes. There is a deficiency of blood, more than an 
impurity; the deficiency is mostly in the red blood glob- 
ules. Anaemia also attends as a striking feature in the 
course of a great number of chronic diseases, such as 
consumption, cancer, Bright's disease, chronic dyspepsia, 
malarial poisoning, etc. 

Note. To get these prescriptions filled, take this book to 
a druggist and point out to him the one desired. 



294 HANDBOOK. 

f The following are some of the evidences or signs of 

Anaemia as given by a noted medical writer : 

"Anaemic patients have coolness of the surface and 
especially cold extremities. They are not so able to 
resist cold as the plethoric [full-blooded]. The action 
of the heart is feeble; the pulse is small, weak, com- 
pressible. The action of the heart is easily disturbed, 
becoming rapid from slight causes, and frequently irreg- 
ular. The mental energy is diminished; persons are 
not adequate to the intellectual efforts of which they are 
capable in health. The strength of will and determina- 
tion of purpose are impaired. The muscular strength is 
diminished. The surface is pallid from the deficiency 
of the coloring matter contained in the red globules. 
This pallor is apparent in the face and especially the 
prolabia [lips]. Mental depression, anxiety respecting 
health, hypochondriasis, irritable temper, want of buoy- 
ancy and energy, a feeling of lassitude, and a painful 
sense of inertia or indolence exist." 

Besides the above phenomena there may be a craving 
for some unnatural thing to eat, such as chalk, slate-pen- 
cils, charcoal, etc. The appetite and digestion are poor, 
and constipation as a rule exists. Shortness or deficiency 
of breath is complained of. 

Ill health of this kind is quite common in girls and 
women, but rare in men; with proper remedies it is 
generally cured. Overwork, mental or physical, indi- 
gestion, or mal-assimilation of food, insufficient amount 
of good food, the want of sleep and rest, too close con- 
finement in over-heated rooms, or the want of out-door 
exercise, are among the obvious causes, but there are 
others more obscure. 

No fact in medicine is better established than that 



SOME COMMON AILMENTS. 295 

mixtures containing Iron, provided they are well borne 
on the stomach, are usually of great benefit to these 
patients, improving the strength, appetite and color. In 
prescribing, bitter tonics are often combined with the 
Iron. The Elixir of Iron and Gentian, and that of Iron, 
Quinine and Strychnine, or the Wine of Iron, are suita- 
ble medicines. 

Fellows' Compound Syrup of the Hypophosphites is 
a good tonic in cases of Anaemia. A mixture called the 
Elixir of Peruvian Bark and Protoxide of Iron is an ex- 
cellent remedy. 

The various Sarsaparilla mixtures are extensively ad- 
vertised and used to improve and " purify " the blood. 
In the opinion of the writer they are very poorly suited 
to cases of Anaemia. 

Another thing in the treatment is of the first impor- 
tance : the appetite and the digestive powers, if poor as 
they usually are, should be improved. Good blood is 
made from good food, well digested and assimilated, not 
from medicine alone. Out-door life and moderate ex- 
ercise, if the habits are sedentary, a change of residence 
and a change of food, freedom from domestic cares, are 
sometimes essential to a cure. If the appetite is poor, 
and if Iron is not well borne, some mixture containing 
one or more of the simple bitters is at first an admirable 
medicine. Constipation almost always exists in cases of 
Anaemia. As an important item in treatment it should 
be remedied. For some excellent directions for the 
cure of constipation read the article on page 281. 



296 HANDBOOK. 

Jaundice, which means a yellowish tinge of the skin 
and white of the eyes, is a noticeable symptom of dis- 
eases of the liver, of cancer in its later stages, of some 
cases of anaemia, etc., but it does occasionally occur as 
an individual, transient, functional disease, ending in re- 
covery in about two weeks. In the latter case, the 
trouble is most commonly caused by a catarrhal inflam- 
mation of the bile-ducts, producing obstruction to the 
normal j>assage of bile from the gall-bladder to the in- 
testine; the bile accumulates in the gall-bladder, and 
in some way bile-pigments (the coloring matter) find 
their way into the blood, giving a yellow tinge to the 
skin. The obstruction may be complete or incomplete. 
It is probable that in many cases the inflammation be- 
gins in the duodenum (the upper intestine), and extends 
into the bile-ducts ; if so, there are at first, symptoms of 
stomach and intestinal disorder, such as nausea,, loss of 
appetite, a coated tongue, a feeling of weight about the 
stomach, possibly vomiting, and either constipation or 
diarrhoea. These symptoms precede for several days the 
change of the color of the skin. But there are other 
causes of inflammation of the bile-passages : exposure 
to cold and dampness, the passage of a gall-stone through 
the ducts, obstruction by a gall-stone arrested in its 
passage. Jaundice is not uncommon after an attack of 
gall-stone colic. In all, or nearly all, cases of Jaundice 
the bile-pigments may be first noticed in the urine, that 
is, the urine has the appearance in color of saffron tea ; 
it stains the linen yellow. The sweat also contains the 



SOME COMMON AILMENTS. 297 

coloring matter and stains the clothing, in some cases. 

Another noticeable sign that the bile does not flow 
from the gall-bladder into the intestinal canal, as is nat- 
ural, is the appearance of the stools or feces, they are 
whitish or clay-colored, the bile-pigment is wanting in 
them, hence the absence of the natural color. Another 
thing, which is quite peculiar, the pulse is often very 
slow, 30 to 40, even lower, a symptom which should 
lead the observer to suspect the nature of the disease. 
The respirations are diminished in frequency. The 
mind is apt to be dull and heavy, and the patient inclines 
to sleep in the day time. There is likely to be itching 
of the skin, especially at night. Many of these symp- 
toms precede the characteristic yellow tint of the skin. 

One writer says that the diagnosis of Jaundice is easy, 
if the examination of the patient is made in the daytime. 
It seems to me that he should have added, provided the 
disease has continued several days, for the skin is nor- 
mal in color during the first stage of the affection. The 
first distinctive symptom is the change in color of the 
urine. Much of the bile is eliminated by the kidneys ; 
the urine becomes yellow, thick and rather scanty. The 
affection is most frequent in youngish persons. It must 
be distinguished from the Jaundice dependent upon 
serious organic diseases of the liver. 

Little need be said regarding treatment, as no medi- 
cine or means are known which cut short the attack, or 
control it in any appreciable degree. Good authorities 
advise that some laxative be taken in sufficient quantity 



298 HANDBOOK. 

to keep the bowels loosened. Fatty foods should not 
be taken, as the presence of bile in the intestinal canal 
is required to digest them. The patient usually desires 
some acid drinks. Cider was formerly regarded as ben- 
eficial, probably lemonade is equally so. If the Jaun- 
dice results from an inflammation, as is generally the 
case, spontaneous recovery takes place in two or three 
weeks. 



SOME COMMON AILMENTS. 299 

THE CARE OF THE EYES. 

BY A SPECIALIST. 

Lying down, leaning your head to one side or in any 
constrained position while reading is a bad thing for the 
eyes. Reading in a poor light is a great strain. If you 
cannot see distinctly at a distance, or cannot read with 
comfort, you need glasses. Get the best quality of 
lenses; their proper adjustment before the eyes and 
their quality are the most important considerations. 
Pebble glass is expensive and scratches too easily. If 
possible, each eye should be fitted separately with the 
proper glass, for they are frequently unlike. If smoked 
glasses give you comfort, get plain glass and not too 
dark. The curved smoke glasses put in rubber frames 
are usually too dark and are just as apt to do your 
eyes harm as good. 

More eyes are destroyed by a poultice than from al- 
most any other cause. In any inflammation cold is gen- 
erally the best application ; it is best applied by putting 
on a cloth dipped in water and laid over the eye, before 
this gets warm have another cold cloth ready, and so on. 

A cinder in the eye may sometimes be removed by 
holding the lids away from the eye and blowing the 
nose. If on the upper lid, have the person look down 
to the floor, then taking hold of the eyelashes pull the 
lid down and out, and then up over a match pressed on 
the lid just above. The cinder when seen is best 
scraped off with a quill tooth-pick. Conjunctivitis is 



300 HANDBOOK. 

when the surface of the eyeball looks red and inflamed. 
There are two kinds most commonly met with: 1st, 
redness with more or less secretion in the nasal corner ; 
2d, some redness with pimples or little ulcers where the 
clear part of the eye joins on to the white part. In this 
second kind the eyes may be sensitive to light. 

Treatment. Don't tie up the eyes, don't poultice, 
don't put on tea leaves or anything of the sort. Take a 
dose of salts and avoid rich food of every kind. In ad- 
dition for No. 1 : get some boracic acid, put a teaspoon- 
ful in a pint of water and bathe the eyes with the solu- 
tion three times a day, taking pains to get some in the 
eyes. Rub vaseline along the edge of the lids at bed- 
time. 

No. 2. Use same wash as in the preceding case ; in 
addition dust a little calomel right on the eyeballs, once 
a day for 3 or 4 days. Granular lids are best treated by 
turning them over and touching very lightly with a 
crystal of sulphate of copper once or twice a week. 

All injuries to the eye must be treated by keeping the 
patient very quiet and using cold applications. When 
the lids are red, or the person has a number of styes, it 
shows poor health, and that the eyes are being strained 
in some way. When the eyes are sensitive or j>ainful, 
following rheumatism or gout, a physician must be con- 
sulted at once. 

The Care of the Ear. Never box any one's ears, 
serious deafness has been known to result. Excessive 



SOME COMMON AILMENTS. 301 

cleanliness is a frequent cause of impacted wax. Nature 
has put the region of .the ear-drum where it cannot be 
easily reached. This is a strong hint to leave it alone 
and not put in ear probes or try to scrub out the inside 
with harsh soap. 

Earache. A little laudanum dropped in will often re- 
lieve. Dry heat is very grateful, heat a napkin over a 
lamp and apply to the ear, having another heated and 
ready before the first one cools and so on. Earache 
may sometimes be relieved by shutting the mouth, hold- 
ing the nose and trying to blow, then swallowing once 
or twice. If the throat is sore use a gargle first before 
blowing in this way. 

Eczema. A little reddened spot will itch, then a scab 
will form with some secretion. The most frequent site 
is behind the ear or at the opening of the orifice. 

Treatment. Avoid pastry, salt meat, tea and coffee ; 
keep the bowels regular. Soften up the scab with vase- 
line, and dust on a little powdered borax or tannin. 
Any soothing application that excludes the air is good. 

Impacted wax. Symptoms : stuffed up feeling in the 
head, gradual loss of hearing, or the hearing suddenly 
regained, then lost again, sensation as if something in 
the ear moved when the head is turned suddenly. To 
remove the wax : put half a teaspoonful of baking soda 
in a pint of hot water. Use a fountain syringe, direct- 
ing the nozzle at an angle (in and down not straight 
in). Don't use much force. Afterward dry the ear 
very carefully. 



302 HANDBOOK. 

Discharge from the ear. Use pure hot water in the 
same manner as above directed. Dip up a very little 
tannin or borax on a quill tooth pick and blow it into 
the ear. Too much powder is apt to cake and prevent 
the proper healing of the ear. Use this treatment every 
6, 24 or 48 hours, according to the amount of the dis- 
charge. 



SOME COMMON AILMENTS. 303 

* SLEEPLESSNESS. INSOMNIA. 

Cover the embers 

And put out the light, 
Toil comes with the morning 
And rest with the night. 

Longfellow. 

King Henry IV.— How many thousands of my poorest sub- 
jects are at this hour asleep, 
Oh, sleep ! Oh, gentle sleep ! 
Nature's soft nurse, how have I frighted thee, 
That thou no more wilt weigh my eyelids down, 
And steep my senses in forgetfulness. 

Shakespeare. 

Our remote progenitors, especially those who lived in 
suburban towns, found little difficulty in obtaining natu- 
ral and refreshing sleep. Physicians now-a-days hear 
much complaint among the "enlightened classes" of 
their inability to sleep well at night. "There is some- 
thing w r rong in Denmark." The want of a proper 
amount of good sleep brings on mental and physical 
exhaustion, indigestion and irritability of temper. It is 
no doubt true that wounds heal quicker and better, and 
recovery from disease sooner takes place if the patient 
sleeps at night. What are the causes of sleeplessness? 

Among the most common are mental and physical 
overwork, dyspepsia, over-eating and eating indigestible 
food for supper, drinking strong tea or coffee, the in- 
temperate use of tobacco, or stimulants, too much care 
and worry, pain, nervous exhaustion and disease. 

Many women of a nervous temperament are not able 
to sleep after attending an evening party, the mind is too 
excited to sleep. There should be regular hours for 



304 HANDBOOK. 

retiring; bodily and mental comfort ought to fee enjoyed 
for a few hours just before retiring. Some light amuse- 
ment, or light reading, which will divert the mind from 
the thought and labor of the day, is very beneficial. 

To those who do not labor, a walk or a ride in the 
evening often acts like a charm. Some persons who are 
light eaters are benefitted by a little light and easily di- 
gested food just before bedtime. 

We come to describe the so-called artificial methods 
of getting to sleep, and they are of considerable impor- 
tance. The secret of all of them consists in an effort to 
keep the mind fixed on some monotonous subject, thus 
preventing it from following out some exciting train of 
thought. 

Many persons say that they cannot get to sleep be- 
cause they cannot stop thinking. The thoughts should 
be turned upon such a dull, monotonous and uninterest- 
ing subject that the person falls into a drowsy condi- 
tion, when consciousness will soon be lost in sleep. 

The writer of this article, to induce that drowsiness 
which precedes sleep, follows out in imagination a road 
leading through an extensive forest, and falls to sleep 
while making the monotonous journey. 

The once famous method of inducing sleep at will, 
invented by one Mr. Gardner, may be tried. It is said 
that it never failed in his own case. 

The method is this : the person lies on the right side 
with the head only a little raised ; he then takes in sev- 
eral full breaths, and continues to breathe through the 



SOME COMMON AILMENTS. 305 

nose with the lips gently closed ; he must then fix his 
mind intently upon the act of breathing and imagine 
that he sees a constant stream of air passing out from 
and returning to his nostrils. As soon as the thoughts 
are centered upon this one idea, consciousness is lost, 
and the person falls asleep. 

Benjamin Franklin advised, if one could not sleep, 
that he get out of bed, throw the bed clothes off, give 
them a good shaking, and walk around the chamber till 
he begins to feel the cold air un}jleasant, then return to 
bed. 

For some persons a bath, warm or cold as is most 
agreeable, just before retiring, has an excellent effect, 
favoring sleep. 

There are some simple medicines, such as valerian, 
skull-cap, henbane, etc., which are sufficiently narcotic to 
produce sleep in some cases. 

Many elderly persons are much troubled about sleep- 
ing. It is certain that some light alcoholic stimulant 
in moderate quantity, taken at night, favors sleep, but 
many persons have scruples against its use, even as a 
medicine for those in the decline of life. 

As a sleep promoter in a certain class of cases, one 
medicine deserves conspicuous mention. We refer to 
the Bromide of Potassium or Sodium. It has its best 
effect in the sleeplessness which results from excitement, 
nervousness, mental overwork, worry and other condi- 
tions in which there is too much blood pressure in the 
brain. It should be taken in much water and in doses 



30(5 



HANDBOOK. 



of 20 grains or more, before retiring and may be repeat- 
ed if required. In case the sleeplessness is owing to 
indigestion, as it often is, the bromides are of little 
good. A cup of ginger tea would be a better remedy. 

German pharmacists have brought out within a few 
years several new hypnotics. One of the best of these, 
perhaps, is Sulphonal ; it certainty has a wonderful ef- 
fect, in some cases, producing continuous and refresh- 
ing sleep for six or eight hours. It needs to be given 
in 15 to 20 grain doses, about two hours before the 
time for sleep, and if needed, may be repeated. 




SOME COMMON AILMENTS. 307 

DISEASES OF THE SKIN, 

COMMONLY CALLED HUMORS. 

A treatise on eommon diseases would not be complete 
without some description of the more common diseases 
of the skin. Uneducated persons have some queer no- 
tions about these humors. If an eruption appears on 
the skin they are apt to think that the body is full of 
humors, and that much medicine is needed to purify the 
blood. As a matter of fact, in many cases, the disease 
is only skin-deep, resulting from some wrong action of 
the skin itself, from direct irritation, and from other 
causes. Another common error is the belief that the 
eruption can be driven in or out, and that there is some- 
times danger in curing the disease on the skin. There 
is no such a thing as a humor through the system that 
can be driven out, or driven in. This notion grew out 
of the "humoral pathology, " now exploded. Skin dis- 
eases, roughly speaking, barring rare causes, are pro- 
duced by some wrong action of the skin itself, by irrita- 
tion, or by disorders of the stomach and intestines, liver, 
or other organs. There appears to be a sympathetic 
relation between the external skin and the internal skin 
— the mucous membrane of the alimentary canal — -so 
that when one is disordered the other inclines to be. 
For instance, such common skin diseases as Eczema, 
Acne, Nettle-rash, etc., are often aggravated, if not 
caused, by disorders of the gastro-intestinal canal. It 
is well known that the so-called " eruptive fevers, " such 



308 HANDBOOK. 

as Scarlet fever, Measles, Small-pox, etc., are attended 
with an eruption upon the skin. These diseases will be 
described in another place. 

Secondary Syphilis is attended with skin-eruptions of 
various kinds, which are too numerous to be described 
here. 

Some brief definitions of the terms used are needed, 
in order that the average person may read intelligently 
the descriptions of skin diseases. 

Papules are pimples, or small elevations of the skin, 
solid, cone-shaped, and generally red. 

Pustules are like papules except they contain a little 
pus or matter. 

Wheals is a term used to designate elevations of the 
skin, of various sizes and shapes, mostly seen in Nettle- 
rash. 

Crusts, in common language, are scales, often seen in 
that common disease, Eczema. 

Vesicles are small water-blisters produced by a collec- 
tion of fluid under the epidermis, or outer layer of the 
skin. When these Vesicles are of large size they are 
called bleds. Vesicles are common in Eczema and 
Chicken-pox. 

Diseases of the skin are more common in infants and 
children, because, for one thing, the skin is active and 
tender, and they are more subject to gastro-intestinal 
irritations. 

The following cut represents the different parts of 
the skin, with their situations and names. 



SOME COMMON AILMENTS. 



309 




Section perpendicularly through the healthy Skin. 

, Epidermis, or scarfskin ; 'b, Rete mucosum, or rete malpighii ; c, Papil- 
lary layer ; d, Derma, corium.'or true skin; e, Pannlculus adiposus, or 
fatty tissue ; f, g, h, Sweat gland and duct; i, k, Hair, with its follicle and 
•papilla; /, Sebaceous gland. / 



Eczema, (Salt Rheum, Moist Tetter.) This is by 
far the most common and important of the skin diseases, 
constituting nearly one-half of all cases of skin diseases 
in children, and a large share of those in adults. The 
eruption manifests itself in varied forms, is acute and 
chronic, and attacks persons of all ages. Eczema may 
be denned as a non-contagious, itching disease of the 



310 



HANDBOOK. 



skin, characterized at first by an eruption of fine vesicles 
(water-blisters) which soon break, pouring out upon the 
surface a moist, sticky substance which, when dried, 
forms scabs or scales. As the disease progresses, vari- 
ous changes take place. The skin is always swollen 
and may be cracked, or pustules (festers) and large 
sores may form. Eczema in infants and children after 
awhile appears as a raw, moist surface, which tends to 
dry into scabs in spots which, when washed off, are soon 
replaced; around the- edges of the patches, where the 
eruption freshly extends, small vesicles may generally 
be discovered. These are distinguishing marks of this 
disease. 

The eruption commonly begins in a number of scat- 
tered, red points w r hich coalesce. As the vesicles run 
together, large water blisters are formed in the acute 
variety. In the cases seen by the writer the skin of the 
face, in the young, was the most common seat of the 
disease. Indeed the humors so frequently seen on the 
face of young children are generally eczematous. 

On the scalp the skin is swollen and painful ; thick, 
yellowish scabs collect, involving the hairs, and giving 
off an offensive odor ; itching is very troublesome. Ec- 
zema attacks the ears and the skin behind them — the 
ears are swollen, and often cracked, and pour out an 
abundant secretion. The same form occurs in the bends 
of the knees and elbows. At the time of nursing it is 
called " milk crust " or « crusted tetter, " at the time of 
teething, " tooth -rash " 



SOME COMMON AILMENTS. 311 

It is not an uncommon thing for a patch of skin on an 
adult to remain for years an itching humor ; it is almost 
invariably eczema. Washerwoman's, bricklayer's and 
grocer's itch are often called " salt rheum " ; it is a form 
of eczema, caused by handling irritating substances; the 
skin is generally cracked and thickened. In oldish per- 
sons, eczema sometimes exists on the lower legs, giving 
rise to itching, burning and j)ain, and sometimes to raw, 
ulcerating sores, of considerable extent. 

The chronic form is much more common in adults 
than the acute. 

" In regard to the causes of eczema they are of two 
kinds ; first, the local ; second, the general or predispos- 
ing. Anything which irritates or inflames the skin can 
excite eczema in one subject to it ; thus we see the erup- 
tion appearing again and again in many cases as often 
as the irritation is repeated. * * * * Poison-ivy may 
start a real eczema, also arnica, croton oil, poisonous dye- 
stuffs, as in some colored socks, or the changes of tem- 
perature, heat and cold, friction, etc. In infants, irritat- 
ing diapers, or neglect to change them promptly, is a 
frequent cause of eczema of the lower parts. And I 
have reason to believe, on the other hand, that the fre- 
quent and careless washings, or irritating soap or towels 
may frequently give rise to it. " 

Among the predisposing causes it is said that stomach 
and bowel disorders, torpor of the liver, rheumatism 
and debility are the most common. 

If some other form of skin disease has continued for 
a time, and there is much irritation of the skin, eczema 
is likely to set in as a secondary disease. 

Eczema is liable to be mistaken for other skin diseases. 



312 HANDBOOK. 

Some points of dissimilarity will be given. These differ- 
ent diseases will be fully described in following articles. 

Erysipelas is always attended with much fever and 
sickness, eczema is not. Erysipelas breaks out at one 
point only and extends from one point in a smooth, 
shining, dark-colored swelling; eczema usually breaks 
out at several points, and the patches are covered with 
fine water blisters, or scabs, or show a raw surface. 

The Itch (Scabies) has a slight resemblance to eczema 
in the vesicles and the itching, but the vesicles are few 
in number, usually on the hands, not on the face where 
eczema is most common in children. 

Pruritus, the itching disease without eruption, is 
sometimes mistaken for eczema. The only visible signs 
of this affection are the pimples brought out by scratch- 
ing. 

Herpes resembles eczema in the appearance of vesicles, 
but they are in isolated groups and not, as in eczema, 
scattered over the skin without regular arrangement. 

Lichen is attended with itching, but the eruption is in 
the form of solid pimples, which remain as pimples, that 
is, they do not become vesicles or pustules, as they do 
in eczema, and the skin is not moist or covered with 
scabs as in eczema. 

Treatment. It is, we think, a well-established princi- 
ple that acute eczema needs soothing treatment, and 
chronic eczema, stimulating applications. In children 
frequent washing of acute eczema with soap and water 
is harmful. A little mild oxide of zinc ointment, or lead 




A Case of Skin Disease 



SOME COMMON AILMENTS. 313 

ointment, may be applied, and covered with oiled-silk, 
or some scorched linen, to prevent friction or chafing of 
the skin. Woolen clothing must never be allowed in 
contact with the diseased skin. 

A few days ago the writer treated a case of acute ec- 
zema of an adult. The best results were obtained by 
dusting over the diseased skin with subnitrate of bis- 
muth or with powdered starch. 

As an application for chronic eczema one writer says 
that carbolic acid is worth all the other remedies. An 
elegant carbolic ointment may be made by mixing 15 
grains of carbolic acid with one ounce of vaseline ; this 
may be freely applied to the eczematous skin ; it pre- 
vents, in a measure, the annoying itching and tends to 
heal the skin. 

Thick scabs sometimes form which need to be re- 
moved. This may be done by moistening them with 
sweet oil, or by putting on a flaxseed poultice. 

German phj'sicians are very expert in the treatment 
of skin diseases. One of their school says that tar is in- 
dispensable in the treatment of chronic eczema. The 
tar ointment may be obtained of any druggist. 

The writer has nearly always succeeded in curing ec- 
zema of infants and children with the zinc ointment 
freely applied ; it should be fresh or it may be too irri- 
tating. 

Acne (Pimples, Flesh Worms.) This skin disease is 
next in frequency to eczema. It consists of an eruption 



314 HANDBOOK. 

of hard, distinct pimples, the most of which soon fester 
or suppurate. It mostly comes out on the face, neck, 
back and shoulders, and is easily recognized. From one 
to fifty acne pimples in different stages of development 
may appear on the face at the same time. It never 
occurs in young children, and is rare before the twelfth 
year, common from the fifteenth to the twentieth year. 
We often see a young person's face covered with red 
pimples ; it is nearly always Acne. 

The cause of Acne is an obstruction and an inflam- 
mation of the sebaceous or oil-glands of the skin. What 
are called grubs, or flesh-worms, are simply hardened 
specks of oily matter retained in the sebaceous glands. 
The humor mars the appearance of the skin to some ex- 
tent, otherwise it is insignificant. 

Treatmeiit. Perhaps the best thing that can be done 
in the way of common treatment is to use much care 
about food. Richly fried meats, fried eggs, oysters and 
sausages, buckwheat griddle-cakes, mince-pies, salt meats, 
cheese, hot bread, nuts and raisins, etc., eaten by some 
young persons are almost sure to bring out a crop of 
acne pimples on the face. If this is found to be the 
case, of course all such food must be avoided. Plain 
food, which agrees with the particular person, must be 
selected. Remedies which improve the digestion are 
sometimes needed. 

A teaspoonful of sulphur, taken every night for 
awhile, is sometimes advantageous. The Seltzer ape- 
rient taken in the morning is beneficial, There are 



SOME COMMON AILMENTS. 315 

some washes and ointments which cure some cases of 
Acne. Stimulating applications may excite the skin to 
more healthy action. We suggest a few remedies which 
are probably as good as any of the many patent lotions 
and ointments advertised as sure cures ; the latter con- 
tain, principally, either corrosive sublimate, sulphur, bis- 
muth or lead. 

A physician says, in the Boston Medical and Sur- 
gical Journal, that he has not failed to cure cases of 
Acne, which come to him, with the following ointment : 

Chrysophanic acid three grains to one ounce of vase- 
line, mix and make an ointment. At night, after the 
face is well washed with soap and hot water and dried, 
the skin is well rubbed with the ointment, and this re- 
peated every night until the skin is reddened, when the 
ointment must be omitted for a few nights. Continue 
this treatment till the Acne is cured. 

A specialist of Philadelphia uses for Acne the follow- 
ing remedies : washing of face night and morning with 
water as hot as can be borne. This stimulates the ab- 
sorbent action of the blood-vessels. 

Externally, after washing, use the following ointment : 

Acidi borici 20 grains, olei eucalypti 5 drops, bismuth 
subnitrat 1 drachm, lanolin 2 drachms, unguenti zinci 
oxide 1 ounce. 

Internally the following : 

Liq. potassii arsenitis 72 drops, tinct. nucis vomicae 72 
drops, aloes 2 grains, aqiue menthae pip. 3 ounces. M. 
Sig. : 1 teaspoonful after meals. 

Mix a little sulphur and flour, equal parts, with suffi- 
cient vaseline to make a paste ; after bathing the skin 
at night fifteen minutes with hot water and soap, dry 
and apply the paste ; wash off in the morning. 

The following, known as Kummerfeld's lotion, has 



316 HANDBOOK. 

been used with great success: Precipitated sulphur 4 
drachms, powdered camphor 11 grs., powdered traga- 
canth 20 grs., lime Abater and rose water each, 3 ounces. 
Mix. Shake the bottle before using. The wash may 
be applied three times a day. 

In some cases, when the skin is coarse and sluggish, 
external remedies may be sufficient to cure, but often 
they must be joined by internal medication. If the 
patient is debilitated and anasmic, tonics are required, 
such as Fellows' Compound Syrup of Hypophosphites, 
or the Elixir of Peruvian Bark and Iron. Dyspepsia is 
often a cause of Acne, therefore it should be cured, if 
possible, by proper diet, out-door exercise and appro- 
priate medicines. Constipation frequently co-exists; it 
should be remedied. For directions as to its cure, read 
the foregoing article on Constipation. It is true that in 
some cases the cause of the disease is obscure ; in such 
instances, the general health should be improved with 
the expectation that the skin will become more active 
and healthy. By some, the laxative mineral waters, 
such as the Hunyadi or the Saratoga, are highly recom- 
mended as curative. 



Psoriasis (Dry Tetter.) "The next most common 
disease is probably Psoriasis, which comes far behind 
Eczema and Acne in frequency, forming only about 
one-fifteenth of the whole number of cases of skin dis- 
eases. Psoriasis may affect persons of all ages, but is 
very uncommon in young children, and seldom develops 
for the first time in persons over forty years of age. It 
is characterized by the presence of separate spots or 
patches of diseased skin, which are of a dull red color, 
and have on their surface (unless it has been removed) 
an abundance of white scales, which fall readily. These 
scales are spoken of medically as micaceous, because 
they are in layers like mica. It is also spoken of as a 
furfuraceous eruption, because of the bran-like character 
of the desquamation, or scaling, which will sometimes 
fill the bed or clothing with scales. 



SOME COMMON AILMENTS. 317 

The separate patches of psoriasis are generally circu- 
lar, and may be of any size. Sometimes large surfaces 
may become covered by the union of a number of small- 
er patches, each one of which has a strong tendency to 
grow larger in diameter. 

Psoriasis has a very decided preference for the outer 
or extensor surfaces of the joints, as on the elbows and 
the front of the leg and knee ; while eczema affects 
more commonly the inner or flexor surfaces, as the bends 
of the elbows and knees. It not infrequently attacks 
the scalp, and there gives rise to much scaling and is one 
of the causes of dandruff. The surfaces of Psoriasis are 
never moist, except when greatly scratched or irritated ; 
while eczema tends to show moist surfaces. Psoriasis 
rarely itches, whereas eczema seldom fails in this. " 

Eczema in its later stages, and when limited to small- 
ish patches, may somewhat resemble Psoriasis, especially 
on the scalp. But Eczema at first is moist, while Psor- 
iasis is not. Psoriasis is generally a chronic disease, like 
Eczema, if cured for awhile, it is likely to return. 

The distinguishing marks of Psoriasis are the dry 
scales in layers, which may be picked off. In Pityriasis 
the scales are branny, and not adherent to each other, 
and easily fall off. For a common remedy tar soap may 
be used in washing these patches. 

Dr. Bulkley, physician to the New York Skin Hos- 
pital, says that the oil of cade 25 parts, sapo viridis 15 
parts, and glycerite of starch, mixed, and well rubbed 
upon the skin at night, cures Psoriasis. As an internal 
medicine, arsenic in some form is the remedy in that 
class of skin diseases in which the skin is covered with 
scaly or branny patches. It should be taken under the 
direction of a physician. 



318 



HANDBOOK. 



Nettle-rash (Urticaria, The Hives.) This peculiar 
eruption comes out suddenly without premonitory symp- 
toms, or is preceded by slight sickness. The rash is in the 
form of blotches, or solid elevations of the skin called 
wheals, varying in size from one-half of an inch to sev- 
eral inches in length ; they are round or oval, in stripes, 
or in other irregular shapes, whitish or rosy in color, and 
surrounded by a little redness of the skin. Burning, 
tingling and prickling sensations are felt, and a strong 
desire to scratch, which if done, brings out more wheals. 

"Urticaria, according to the duration of the disease, 
may be described as acute or chronic. The acute vari- 
ety is commonly, though by no means invariably, ush- 
ered in by slight febrile symptoms, languor, headache, 
depression, gastric disturbance, furred tongue, etc. The 
efflorescence appears suddenly, and may involve the 
whole body or a portion only, accompanied by intense 
and almost intolerable burning and stinging sensations. 
In a variable time, from an hour to a day, the symp- 
toms subside, and the eruptions disappear without leav- 
ing a trace unless in the form of scratch-marks. The 
termination of the attack is greatly influenced by the 
removal of the exciting cause, as well as by active treat- 
ment. Relapses may take place. Chronic urticaria 
may continue for months or years, or, indeed, as long as 
the cause exists. The individual wheals come and go 
as in the acute form ; the lesions, however, are usually 
smaller. Crop after crop may appear, the skin being 
hardly ever free from them. The patient's general 
health may appear fair. 

The causes of urticaria are numerous, and of a very 
diverse character. Certain external irritants and poi- 
sons to the skin, as the stinging nettle, jelly-fish, cater- 
pillars, fleas, bedbugs and mosquitoes, are not infrequent 
causes. Among internal causes, gastric and intestinal 
derangements are by far the most common; they in 



SOME COMMON AILMENTS. 319 

fact are the cause of the majority of acute urticarias. 
An over-loaded stomach, excess in wine, beer, or highly 
seasoned food may occasion an attack, while certain ar- 
ticles of food, as fish, oysters, clams, crabs, lobsters, 
pork, especially sausage, oatmeal, mushrooms, raspber- 
ries, and strawberries are all apt to bring out the eruption. 
A number of medicinal substances may also bring on an 
urticarial eruption in some individuals. In most cases 
of urticaria from these causes, a certain idiosyncracy 
seems to exist. Any irritation of the bowels, as of 
worms in children, may bring out the eruption. Sud- 
den emotion or unusual excitement in certain persons 
may also produce it. In females menstrual and uterine 
difficulties may cause urticaria. The disease is inti- 
mately connected with the nervous system, and patients 
with chronic urticaria are apt to be persons of more or 
less depraved nervous organization. 

The diagnosis of urticaria does not often present any 
difficulty. The peculiar and evanescent character of the 
eruption, the excessive burning and tingling, mark it as 
something different from other skin diseases. " 

In the way of treatment a few remedies are given. 

Menthol dissolved in alcohol makes a good wash, 
generally relieving the troublesome prickling and itch- 
ing. 

A quart of water, to which a solution of carbolic acid 
and two ounces of glycerine have been added, makes an 
excellent wash. If anything has been eaten, which is 
the probable cause, an emetic should be taken immedi- 
ately to empty the stomach. A few doses of Epsom salts 
are often beneficial, taken in sufficient amount to loosen 
th e bowels. 

While the cause of Nettle-rash is generally some er- 
ror in diet, it is not always easy to say just what the 



320 HANDBOOK. 

offending food is ; on this account, in chronic cases, one 
kind of food after another must be left off till it is 
known what particular kind disagrees. It is said that 
coffee with some persons brings out the rash. I have 
seen to-day a case of Nettle-rash which has been troub- 
lesome for ten days. The patient is suffering from con- 
siderable disorder of 'the stomach and bowels which is, 
in this case, the cause. 

Erythema is an efflorescence, or mild inflammation 
of the skin, appearing in patches of uniform redness, 
which disappear momentarily on pressure with the fin- 
ger ; there may or may not be swelling of the skin. In 
its simple form there is no disturbance of the health, that 
is, on account of the eruption. Erythema is interesting 
on account of the fact that it is liable to be mistaken for 
more serious diseases. The redness caused by a mus- 
tard plaster, by a sUght burn, by exposure to the hot 
rays of the sun, by chafing in infants, are examples of 
simple Erythema. 

Several varieties of Erythema are described. (1) The 
patches of redness may be fleeting, quickly leaving one 
part to appear on another. (2) It is sometimes in rings 
or circles, etc., the skin in the center being healthy look- 
ing. (3) That form which appears in the folds of the 
skin, the arm-pits and groins, etc., of infants and fleshy 
women. (4) Eczema is often preceded and accompan- 
ied by an inflammation of the skin which is Erythema. 
In some forms of Erythema there may be slight burn- 



SOME COMMON" AILMENTS. 321 

ing, tingling or itching, but often there is none. In in- 
fants and children, disturbances of the stomach and 
bowels, teething, chafing, and irritation of the skin by 
discharges from the bladder and bowels are the frequent 
causes. 

Erythema slightly resembles erysipelas, and by ignor- 
ant or dishonest quacks it is often called by the latter 
name to make a good case. 

In the way of treatment but little is needed. In in- 
fants the skin should be kept clean and dry and dusted 
with prepared chalk or bismuth ; in adults the zinc or 
lead ointment may be applied. 

Erysipelas (St. Anthony's Fire.) Much that passes 
under the name is not Erysipelas at all, but is some oth- 
er, and milder skin disease, such as Erythema, Eczema, 
etc. Erysipelas is an acute, constitutional disease attend- 
ed with fever and an inflammation of the skin. It usual- 
ly begins abruptly and with chilly sensations, followed by 
fever, and the usual fever symptoms, such as headache, 
backache, and aching in the limbs, thirst, excited pulse, 
etc. In infants nausea and vomiting, and frequently 
convulsions, precede the rash. The disease is quite com- 
mon in adults, and occasionally seen in infants, but is 
rare in youth. There seems to be some poison or un- 
healthy condition of the body which occasions the out- 
break. Erysipelas, in a certain sense, is a contagious dis- 
ease. The inflammation of the skin usually starts from 
some wound, sore, or abrasion of the skin. In infants, 



322 HANDBOOK. 

the vaccine sore, the navel, or the genital organs are parts 
frequently attacked. In adults, the face or scalp is by 
far the most common starting point of the redness. 

When in addition to the above named fever symp- 
toms, an inflammation of the skin begins in the form of 
a dark-red patch, spreading with raised border, attended 
with more or less burning or prickling pain, and with a 
shining and swollen appearance of the skin, and a con- 
dition which allows it to pit on pressure with the finger, 
it may be named Erysipelas without much chance for 
mistake. The characteristic thing about it is, that it 
spreads from one point, and does not break out in nu- 
merous points over the body, that it spreads in a well 
marked ridge above the healthy skin, is dark-red in 
color, and is ushered in by much constitutional disturb- 
ance. After 24 hours large water blisters may appear 
on the inflamed skin. 

In an adult, previously healthy, when the constitu- 
tional symptoms are not very severe, and when the in- 
flammation of the skin is confined to the face and scalp, 
the disease usually runs its course in one or two weeks 
and ends in recovery. In aged and feeble persons, es- 
pecially if the rash appears on the extremities, the attack 
is likely to terminate fatally. Every case of Erysipelas 
occurring in infants, which the writer has seen, ended in 
death. A celebrated French physician says: "The 
Erysipelas of infants is a fatal disease." 

Treatment. If a physician cannot be found the fol- 
lowing domestic remedies may be used : 



SOME COMMON AILMENTS. 323 

Grated raw potatoes made into the form of a poultice 
applied every hour ; a bread poultice, not too hot, can 
be used and changed every 3 hours. 

A mixture of sweet oil or linseed oil and spirits of 
turpentine, equal parts, painted over the inflamed skin, 
is good treatment ; cloths wrung out in a weak solution 
of carbolic acid, alcohol, or vinegar and water, may be 
applied. Most physicians advise painting the healthy 
skin around the erysipelatous patch with tincture iodine, 
to prevent spreading. 

Pruritus is the itching skin disease without eruption 
or other visible signs of disease, excepting the skin after 
awhile shows more or less pimples and sores caused by 
scratching. The writer has to-day seen a case of Pru- 
ritus, the patient being a woman 75 years of age. The 
itching is confined to the arms and is very troublesome. 
Nothing is to be seen except a few pimples after scratch- 
ing. In some instances of intense itching, visible signs 
may be discovered which are evident causes — body lice 
upon the skin or in the clothing. 

Pruritus may be local, that is, prolonged itching may 
be confined to some particular and small part of the 
body, or to some organ ; perhaps this variety is fully as 
common as that involving larger extent of the skin. 

A form of winter-Pruritus is thus described : "It is 

Note. While engaged in writing this article 1 have had an 
office patient who suffered from Pruritus of the local variety. 
The part was first irritated by an unhealthy discharge, and 
the scratching has brought out an eruption of Eczema. The 
application of hot water, followed by the use of this ointment 
was advised : creasote 1 drachm, vaseline 1 ounce. Mix, and 
put on night and morning. 



324 HANDBOOK. 

commonly observed upon the lower extremities, particu- 
larly the insides of the thighs and calves of the legs, 
although it may occur upon the upper extremities, and 
may assume almost a universal form. The peculiarity 
is, that it leaves its victim free during the summer 
months, only to return promptly with the frosts of 
autumn, year after year. During the winter a spell of 
clear, bright, frosty weather will bring on a tormenting 
attack, which will pass away when the weather becomes 
warm and moist. The itching comes on when the 
patient takes oft" his clothing at night, and seems to be 
excited by the impact of cold air. " 

This is an exact description of the disease as it occurs 
in the writer's own person. After the first cold ride in 
the autumn the itching begins in the evening and is con- 
fined to the legs. The trouble continues through the 
first part of the winter, entirely disappearing in warmer 
weather. 

In the way of treatment it may be said that Pruritus 
is an obstinate disease, very difficult to cure. The ap- 
plication of water as hot as can be borne is one of the 
best means of relief in some cases. Some washes, such 
as the 10 per cent, solution of carbolic acid, or a solu- 
tion of Menthol in alcohol and water is followed by 
good results. The writer has obtained the best results 
by rubbing over the itching skin with a mixture com- 
posed of creasote one part, glycerine three parts. A 
high authority on skin diseases j^rescribes the following 
wash : carbolic acid 3 drachms, glycerine 1 ounce, water 
1 pint. Mix. 

One writer recommends essence of peppermint when 
other remedies fail, another advises that the peppermint 



SOME COMMON" AILMENTS. 325 

be mixed with an equal quantity of glycerine and 
brushed over the skin. 

Phthiriasis is the medical name given when there 
are lice upon the skin and an eruption which they pro- 
duce. The body louse is the largest and the easiest de- 
stroyed. They are seldom discovered on the skin, but 
may be found in the folds of the underclothing, especial- 
ly where it presses on the shoulders and hips. In some 
cases body-lice occasion prolonged and troublesome itch- 
ing and the scratching produces large sores. If a correct 
diagnosis is not made no progress will be made towards 
a cure. Entire change of underclothing and bed linen, 
together with warm baths of soap and water, and bak- 
ing or boiling the clothing so as to destroy the lice and 
nits, are all that is needed for a cure. 

The Itch (Scabies) is caused by the presence on or 
in the skin of minute animal parasites, the itch mites. 
These insects are so small that they are only visible to 
the naked eye when placed on a black background. The 
female burrows under the epidermis to deposit her 
eggs ; the tract which is thus made is the distinguishing 
mark of the disease; it resembles an old pin scratch, 
roughly speaking. By inserting the point of a pin along 
the burrow the little animal may be removed and exam- 
ined with a magnifying glass. In Boston it was the 
practice, when a part was suspected of being the seat of 
the Itch, to rub the skin over with ink, then wash it, 
because the ink stains the rough burrow tracts, so that 



326 HANDBOOK. 

they can be seen and found, if present. At the head of 
these tracts little vesicles, or water blisters, are some- 
times seen. The most common seat of the disease is 
the skin between the fingers or toes, the wrists or feet. 
The face is seldom touched, differing in this respect from 
eczema, an itching disease, which often attacks the face. 

Treatment. The disease is easily cured. In what is 
called the quick cure the patient is treated thus : at 
night, just before retiring, he is very thoroughly bathed 
in warm, soapy water — a good scrubbing should be 
given ; the skin should then be dried, after which the 
sulphur- ointment must be thoroughly rubbed into the 
skin ; some old night dress may now be put on and the 
patient put to bed. This treatment may be followed 
two nights in succession, at the end of which time the 
itch -insects will be killed. 

Ringworms. There are several kinds of eruptions 
which are called in popular language ringworms, or run 
rounds. They are alike only in their circular form. 
There is no worm about them ; the resemblance to a 
worm is altogether fanciful. Two, or perhaps more, of 
the varieties are trivial things and soon heal of them- 
selves ; the others are more obstinate and require skill- 
ful treatment, besides they are contagious. 

The most frequent kind is (1) a kind of Herpes, and 
begins as a circular patch of vivid red skin, around 
which small, pearly, water blisters or vesicles break out ; 
the redness fades in the center and is covered with dry, 
branny scales, while the circumference increases. These 



SOME COMMON AILMENTS. 327 

rings come out on the face, neck, breast and arms, and 
run their course in 8 or 10 days. 

(2) Another form is called the rainbow ringworm, 
because there are several rings one within another and 
differing in color, each well studded with pearl-like, 
small blisters. Both kinds are attended with some de- 
gree of pricking, burning and itching. When they 
come out repeatedly, as they sometimes do in children, 
it is a sign that the general health needs improving. 
The other form is due to a parasitic growth upon the 
skin, technically called tinea ; it is a contagious disease, 
akin to barber's itch. 

Rose rash (False Measles) is a non-contagious, and 
mild disease of the skin, most common in children, ap- 
pearing as rose-colored spots of varying and small size, 
and irregular shape, scattered over more or less of the 
surface of the body. A mild fever often attends the 
rash, and sometimes there is redness of the throat. The 
rash is bright red at first ; it remains on the skin from a 
few hours to several days. It is often a transient blush 
in spots, with but little, if any, disturbance of the health, 
but in many cases fever and lassitude are noticed at the 
time of the eruption, or just before. The delicacy of 
the skin in infants predisposes to this affection, and any 
disturbance, such as teething, or disorders of the stom- 
ach and bowels, are sufficient exciting causes. 

But little is needed in the way of treatment. If the 
stomach and bowels are disordered, some laxative, such 
as castor oil or rhubarb, may be given. 



328 



HANDBOOK. 



Lichen is an eruption of pimples, commonly red, but 
may be flesh-color, grouped in patches or isolated, at- 
tended with tingling, prickling and itching. As recov- 
ery takes place the pimples dry up, leaving a thickening 
and roughness of the skin. 

It is often an acute disease, lasting one or two weeks, 
but oftener a chronic disease. The front part of the 
limbs and the back are favorite seats of these itching 
pimples. The little rashes which appear in the skin of 
nursing and teething children are often forms of lichen 
simplex, and are sometimes called " red gum " or "prick- 
ly heat. " If the eruption is very troublesome the skin 
should be dusted over with such soothing powders as 
finely powdered starch or with bismuth (subnitrate.) 

Herpes. In the course of a common cold Herpes 
sometimes breaks out about the mouth and lips, and is 
then called a " cold sore " ; three or four water blis- 
ters, from the size of a pin-head to a split pea, appear in 
a cluster on an inflamed base ; there is usually a burn- 
ing pain or a stinging sensation. In exceptional cases a 
painful sore of considerable extent is formed. 

The same thing sometimes appears in the course of 
pleurisy, pneumonia and some of the fevers. A typical 
and plainly marked case of Herpes is seen in Shingles, 
or Herpes Zoster, a description of which is given on 
page 105. One of the kinds of so-called "ringworm" 
is herpetic in its nature. The reddened skin is studded 
with a crop of vesicles. 

Pityriasis. This consists of a chronic inflammation 



SOME COMMON AILMENTS. 329 

of the skin in patches, attended with redness and itch- 
ing. These patches are finally covered with a great 
quantity of minute, bran-like, white scales or scurf, 
which are constantly falling off. The disease may at- 
tack any part of the body, but is by far the most com- 
mon on the parts of the skin covered with hair ; thus 
it constitutes the principal form of dandruff. It is occa- 
sionally seen on the sides of the chin, around the mouth, 
and on the forehead of children having a fair and deli- 
cate skin. It is a difficult thing to. cure the disease ; it 
often continues and occasions a very disagreeable itch- 
ing of the scalp, and dandruff. 

Skin-Cancer (Epithelioma.) A little scaly patch or 
spot, or something slightly resembling a little wart, is 
frequently seen on the nose, face or lip, generally giving 
no trouble unless the scab is picked off often, or irritat- 
ed with salves or caustics, when it may result in exten- 
sive ulceration. An old name for the disease was noli 
me tangere, which means "touch me not"; thus the 
name intimates that there is danger in meddling with 
these things. Although this skin disease is often called 
a cancer, it is hardly a true cancer. The best treatment 
is to let them alone, as long as they remain stationary, 
and do not ulcerate ; when they do, they should be 
thoroughly cut out, or burnt out. A cancer of the lip, 
or a smoker's cancer, is an epithelioma. It should be 
removed as soon as its nature is known. 

Liver Spots, Moth, (Chloasma.) These terms are 
applied to a disordered action of the pigments or color- 



230 HANDBOOK. 

ing matter of the skin, showing themselves principally 
on the face and neck as smooth, brownish patches of 
skin, arranged almost exactly alike on both sides of the 
face. It is doubtful whether the liver has anything to do 
about causing them. Washes are advertised to cure or 
remove these spots, but there is nothing that will do it, 
excepting some caustic, which first destroys the epider- 
mis or outer skin ; corrosive sublimate is one of these 
caustics ; it is a poisonous substance. If removed, the 
spots are likely to return. 

Ivy Poisoning. The humor or eruption brought 
out on the skin by the poison ivy, and its treatment, are 
described on page 157. 



DISEASES OP INFANCY AND CHILDHOOD. 331 



PART V. 

Diseases of Infancy and Childhood. 

APHORISMS. 

The invasion of acute diseases, in infancy and child- 
hood, is often out of proportion in severity to the after 
course of the disease. 

In the very young the invasion of acute diseases is 
sometimes ushered in with vomiting or convulsions; 
drowsiness and apathy are common. The fever-heat, 
and the rapidity of the pulse and respiration, are often 
so great that they would point to a fatal termination in 
the adult. 

High fever, accompanied by restlessness and convul- 
sions, may disappear within twenty-four hours, leaving 
no traces of disease. Disease runs its course with a 
rapidity not seen in the adult ; complications follow each 
other in quick succession. 

The reparative power in the young is much greater 
than in the adult; wounds, broken bones and sores heal 
quicker. Disease is not apt to become chronic in the 
young; recovery or death sooner takes place than in 
the adult. Children respond better to remedies than 
adults do. 

In children from eight to twelve years old, very rapid 
growth is sometimes attended with lassitude and pains 
in the joints and limbs, called "growing pains." 

The discharge from the bowels of infants is often 
green from simple causes, such as indigestion, over feed- 
ing, the action of cold, etc. 



332 HANDBOOK. 

The practice of giving a mild cathartic, as the first 
thing in the treatment of the diarrhoeas of children, is 
for the purpose of clearing the intestines of irritating 
acid, or other offending matter, which, if allowed to re- 
main, would keep up the diarrhoea. 

Frequent and watery (serous), almost colorless dis- 
charges from the bowels, is the most dangerous form of 
summer diarrhoeas. 

In early life, a little error in diet, which would he 
trivial in the adult, may give rise to vomiting, diarrhoea, 
and to violent convulsions; for instance, changing the 
cow's milk with which the infant is fed, or changing 
from one kind of artificial food to another. 

Convulsions, night terrors and the symptoms attribut- 
ed to worms, may frequently be traced to indigestion or 
an error in diet. 

The symptoms which the round intestinal worm give 
rise to are very much like some of the symptoms of in- 
digestion. The only positive sign of worms is the 
actual sight of them. Children under two years of age 
seldom have worms. 

The indigestion of the young is usually acid, on which 
account some alkali is plainly indicated, such as lime 
water, soda, magnesia, the aromatic spirits of ammonia, 
etc. 

It is probable that in hot weather chemical changes 
rapidly take place in milk that render it poisonous to 
infants, and cause many cases of diarrhoea and inflam- 
mation of the bowels. 

Milk is often tainted and poisoned from exposure to 
air made foul by gases from decomposing animal mat- 
ter; on this account infants artificially fed do much 
better in the country. 

Rapid wasting and blanching of the face and lips, 
with deeply sunken eyes, is a sign of intestinal disorder. 



DISEASES OP INFANCY AND CHILDHOOD. 833 

Infants do not need food the first twenty-four hours 
of their existence, but hundreds have been made sick 
and died from artificial feeding at this period. 

No infant needs castor-oil the first days of its life; if 
it can nurse, the first secretion from the mother's breast 
is sufficiently laxative. 

The hot weather diarrhoeas of infants are often caused 
by too much milk from the mother's breast, or from the 
bottle. The infant is thirsty, and nurses for the sake of 
the drink; the digestive powers are over-taxed, diar- 
rhoea results. Pure cold water should be given for 
drink. 

Grinding the teeth in sleep, itching of the nose and 
anus, and pallor about the mouth, are evidences of irri- 
tation or disorder of the stomach and bowels. The irri- 
tation may and may not be caused by worms. 

The nervous system of the young is extremely excita- 
ble ; on this account spasms, fits and convulsions are 
common. A slight irritation in some part of the body 
is a sufficient exciting cause for such attacks, in some 
children. 

As a rule, a single convulsion occurring in a child 
previously healthy has no bad meaning, excluding cases 
in which it is the initial symptom of some acute disease ; 
and then the after-coming disease may not be severe ; 
but a convulsion occurring in the late stages of disease 
usually signifies that death is nigh. 

Convulsions occurring in the first infancy and contin- 
uing through the second, usually become ejnlepsy. 

Convulsions recurring during the course of whooping 
cough, pneumonia, and in the latter stages of scarlet 
fever and brain diseases, signify that the case will ter- 
minate fatally. • 

Moderate fever and cough characterize acute bron- 
chitis, the most common disease of the young. An in- 
fant with high fever and a cough, whose nostrils dilate 



334 HANDBOOK. 

and contract forcibly at each breath, probably has acute 
pneumonia or severe bronchitis. 

In pneumonia, bronchitis and pleurisy, the cough is 
sometimes painful and suppressed, causing the child to 
cry just before, or while coughing. Bronchitis in the 
very young easily runs into lobular pneumonia. 

Primary pneumonia seldom occurs in nursing infants ; 
it is usually secondary, following bronchitis, measles, 
whooping cough, or some fever. 

The "expiratory moan," which means a little moaning 
or grunting sound at each breath, in a sick child, is a 
sign of pneumonia or pleurisy, 

The syrup of ipecac, given early and in sufficient 
quantities to produce vomiting, is of great benefit in 
breaking up or mitigating an attack of bronchitis in 
children. 

Spasmodic, or false croup, begins suddenly after the 
first sleep in the night, and is characterized by difficult 
and noisy breathing and a loud ringing, crowing cough. 
An emetic, generally, relieves the patient ; but an attack 
may return the next night. 

Spasmodic croup may generally be distinguished from 
true or membranous croup from this fact : the former 
begins suddenly and usually decreases rapidly in inten- 
sity after the use of an emetic, and sometimes without 
it ; the latter comes on slowly and gets progressively 
worse in spite of remedies. 

Diphtheria begins with f everishness, sore throat, often 
with vomiting. After the lapse of twelve to thirty-six 
hours patches of membrane appear in the throat on a 
deeply red surface, on or near the tonsil ; they are whit- 
ish or grayish, darker with age, and look very much 
like pieces of putty stuck upon the throat ; they cannot 
be brushed off easily, and if removed, quickly return. 

Small fibrinous masses, liable to be mistaken for true 
diphtheretic membranes, sometimes collect upon the 



DISEASES OF INFANCY AND CHILDHOOD. 335 

throat in common inflammatory diseases of this part ; 
they are soft, cheese-like masses, which can be easily 
brushed off. 

Nasal diphtheria is the most insidious and the most 
deceptive form of the disease. Its early symptoms are 
like those of a common cold, attended or soon followed 
by swelling at the angle of the lower jaw. 

Young children are much more susceptible to the 
contagion of diphtheria than adults are, and they should 
by all means be kept away from it. 

In health the infant's mouth is moist and pale ; the 
tongue smooth and partly covered with a layer of whit- 
ish mucus ; the gums red. and the breath free from odor, 
except the smell of the mother's milk. From indiges- 
tion the mouth becomes hot, dry and red, the breath hot 
sour and acid. 

The skin of the young, being very vascular, delicate 
and sensitive, is very liable to inflammation and disease ; 
on this account skin diseases, -commonly called humors, 
are very common. 

Error in diet, causing indigestion and intestinal irri- 
tation is the most common cause of skin disease in 
children. 

Many skin diseases are caused by dirt and uncleanli- 
ness, and direct irritation of the delicate skin, and not 
by humors in the blood, as mothers and nurses are apt 
to think. 

Eczema, is the most common skin disease, constitut- 
ing nearly three-fourths of all cases of diseases of the 
skin in the young. 

Measles begins with catarrhal symptoms, very much 
like a common cold. The disease is easily known on the 
fourth day when the characteristic eruption appears, 
which is in dark colored blotches and a little raised. An 
earlier symptom is the appearance of the rash on the 
uvula and roof of the mouth. The danger to life in a 



336 HANDBOOK. 

case of measles is from complications, bronchitis, pneu- 
monia, etc. 

In chicken pox the skin looks very much as if it had 
been sprinkled with a little hot water, each drop making 
a small water blister. This peculiar eruption, and possi- 
bly a little languor and slight fever, are about the only 
symptoms of the disease. 

Scarlet Fever often begins abruptly with vomiting, 
sore throat and high fever; but the peculiar mark which 
distinguishes it from other fevers is a scarlet rash, which 
appears on the skin at the end of about twenty-four 
hours from the beginning of the sickness. 

Infants, less than one year- old, do not easily take 
scarlet fever ; children from two to seven years are most 
susceptible to the contagion. After ten years the 
chances of escape are much greater, and if the disease 
is contracted, the danger to life is greatly lessened. 

German Measles is nearly always a mild disease with 
an eruption somewhat like that of scarlet fever and 
usually attended with sore throat. 

Whooping-cough until late years ranked third in the 
fatal diseases of infancy in London, New York and 
Philadelphia. It is most fatal to children under three 
years of age and in cold weather. 

Contraction of the eyebrows, turning the eyes and 
face away from the light ; disturbance by noises, as if in 
pain, are signs of headache. 

Frequent carrying the hand to the ear and pressing 
the ear against the mother's breast are signs of earache. 
Persistent crying of a child, if no other sufficient cause 
can be found, should always lead one to think of earache 
as the possible cause. The cry from colic is boisterous 
and paroxysmal ; the legs are drawn up to the body, the 
face is often purple, the hands and feet cold, the belly 
distended and hard, and the face shows an expression of 
real suffering:. 



DISEASES OP INFANCY AND CHILDHOOD 337 

It is a wise provision of nature that children do, to 
some extent, cry ; the act of crying expands the lungs, 
exercises the muscles of the chest, increases the healthy 
action of the skin, improves digestion, nutrition and the 
growth of the body ; it is a mistake to try to prevent 
infants from crying at all. 

It may be regarded as a favorable sign if a child cries 
when severely sick, if it is not immoderate : for children 
in the later and dangerous stages of disease, as a rule, 
do not cry. 

In an infant more than four months old, absence of 
tears when crying is regarded as an unfavorable sign in 
a sick child. 

Thick matter collecting between the eyelids in a very 
sick child is a bad ,sign, mostly noticed in brain and in- 
testinal diseases just before death. 

Convulsions occurring in the later stages of severe 
diseases are usually a sign that death is nigh. 

Transient or momentary flushings of the face, ears and 
forehead, occurring at irregular intervals, in a sick child, 
is a sign of disease of the brain, if other symptoms con- 
firm the probability. 



338 HANDBOOK. 

SORE MOUTH IN CHILDREN. (STOMATITIS). 

' This affection has various forms, and is most fre- 
quently found in connection with disturbances of the 
stomach or bowels, or both. Usually the different forms 
are easily recognized, and are readily controlled by 
proper remedies. There are three principal varieties : 
(1) The simple, or catarrhal. 2) The ulcerative. (3) 
The follicular. 

The simple or catarrhal form occurs during the first 
dentition [teething] and is usually mild, and may be 
overlooked in the absence of co-existing disease; it 
occurs in children of feeble constitution, depressed by 
bad hygienic surroundings, and is a frequent complica- 
tion of protracted diarrhoea. Infants artificially reared 
are more liable to it, for there is no artificial food how- 
ever skillfully prepared, that is so easily assimilated as 
the mother's milk. 

This form is characterized at first by dryness, and more 
intense redness of the mucous membrane of the mouth 
than in the normal condition ; the gums are sometimes 
swollen and tender, and later the salivary secretion is 
much increased, causing the infant to drool to a trouble- 
some degree ; there may be but little suffering in mild 

Note. Many of the ailments most common in infancy 
and childhood have been described in foregoing parts of this 
book, such as Convulsions, Spasms, Earache, Toothache, etc. 
These may be found by referring to the Index. Diseases of 
the skin (humors), as a class, are most frequent in the young ; 
these diseases have been fully described in preceding parts. 
See page 307. 



DISEASES OF INFANCY AND CHILDHOOD. 339 

cases, but in some instances there is much fretfulness, 
especially when food is given ; the disease is sometimes 
called nursing sore mouth. Recovery takes place in a 
short time, unless some other protracted and serious 
disease exists. In the treatment of this form the child's 
general health should be looked after and the best of 
hygienic surroundings should be enforced. One drachm 
of pulverized borax to one ounce of syrup or gum Arabic 
emulsion may be applied as a wash ; weak solutions of 
alum are also very beneficial ; water to which a few drops 
of the tincture of golden seal have been added, is also a 
good remedy; these solutions may be applied with a 
little swab or brush. 

(2) The Ulcerative form begins as a severe simple 
stomatitis with the additional ulcerous element; the 
gums are usually primarily invaded, and the inflam- 
mation extends along the mucous membrane of the 
cheeks and lips ; wherever it commences it is soon fol- 
lowed by small white points under the mucous mem- 
brane, producing small elevations ; this is often called 
white canker. These spots often unite, giving rise to 
large ulcerative tracts, while others remain isolated ; in 
the folds of the cheek mucous membrane they are more 
elongated, while inside of the lips they are more nearly 
circular. This form of stomatitis is usually confined to 
those parts impinging upon the gums, but sometimes 
it invades the mouth much more extensively. 

The ulcerous, as the simple form, is caused by un- 
cleanliness, poor and scanty food, unhygienic surround- 



340 HANDBOOK. 

ings, and acute diseases which debilitate and enfeeble 
the system, such as lung and bowel troubles, fevers, 
dysentery, etc. 

The symptoms present more severity than the simple 
form; there is much more fretfulness from pain and 
soreness, and much more drooling ; sometimes the glands 
under the jaw are swollen, hard and tender ; the infant 
nurses less eagerly than usual, and may even refuse to 
take nourishment. This form also is often called "cank- 
er" in the mouth. 

Treatment. Strive to find out the cause and remove 
it. Change of residence, if unfavorable, change of diet, 
cleanliness, with an abundance of pure air ; if the child 
is anaemic, which is indicated by pale lips and face, 
tonics are needed. 

In a large proportion of these cases there is a his- 
tory of chronic intestinal inflammation, which demands 
special treatment. As an application to the ulcers, car- 
bolic acid in its full strength, carefully applied, is very 
useful. Chlorate of potash is much employed, given in 
two or three grain doses, several times daily. 

(3) The Follicular form is so named from the fact 
that the ulcers are confined to the follicles of the mucous 
membrane, or to tissues in close proximity. At first 
minute, tender red hard papular elevations appear ; as 
the inflammation continues they enlarge and soon look 
like small water blisters (vesicles) ; these vesicles are 
apt to rupture and leave an ulcerated surface. These 
changes take place during a period of four or five days. 



DISEASES OF INFANCY AND CHILDHOOD. 341 

The ulcer which is the result of the eruption is hard 
and painful, and the base has a grayish appearance ; the 
reparative process now commences, when the ulcer be- 
gins to present a more healthy appearance, gradually 
diminishing in size, and finally healing occurs; their 
number vary from six or eight to, perhaps, fifteen ; they 
are usually discrete, and about one eighth of an inch 
across them; the different stages succeed each other 
rapidly and usually require six or eight days. The seat 
of the disease is inside the cheeks and lips, and on the 
tongue and gums, and may occupy the roof of the 
mouth. The cause is somewhat obscure, but probably 
is most usually associated with derangement of the di- 
gestive organs, and is most frequently seen during the 
time of teething. 

The ulcers are evidently tender and painful ; there is 
usually more or less salivation, and much restlessness of 
the patient. Diagnosis of the disease is usually easy. 
It is to be distinguished from the ulcerous form which 
affects a considerable part of the mouth, while in the 
follicular form the inflammation is usually confined to 
the immediate vicinity of the ulcers. In the ulcerous 
form there is a great variety in form and size of the 
ulcers, while in the follicular form there is more uni- 
formity in both respects ; their small circular form char- 
acterizes them. This form usually ends favorably. 

Treatment. Follicular Stomatitis when discrete and 
unattended with constitutional disturbances is usually 
readily cured with local remedies. Mucilages of gum 



342 HANDBOOK. 

Arabic, or flaxseed, can be applied. Mild astringent 
lotions, such as borax and honey, are effectual and easy 
to use. If the ulcers are slow to heal and painful, they 
may properly be penciled with Nitrate of Silver. Ton- 
ics and nutritious diet may be indicated. 



DISEASES OF INFANCY AND CHILDHOOD. 343 

TEETHING. (DENTITION). 

Between the sixth and eighth months the two lower 
central incisor teeth are cut. 

Between the eighth and tenth months, the upper cen- 
tral incisors appear, soon followed by the upper lateral 
incisors. 

An interval of about four months follows in which no 
new teeth appear. 

From the twelfth to the fourteenth month, more teeth 
are cut and in this order : two upper molars, two lower 
incisors, two lower molars. 

Between the sixteenth and twenty-second months the 
four canines are cut ; between the twentieth month and 
the end of the year the four back molars. This makes 
twenty milk teeth. This is called the first dentition. 
No more teeth are cut till the fifth or sixth year, when 
the eruption of the permanent teeth begins. 

This is the normal order of eruption of the first teeth, 
but there are many cases in which it is not followed. 
The upper incisors are often cut first. The lateral or 
side incisors, sometimes appear before the central. In 
rarer cases the molars, or possibly the canines precede 
the incisors. 

There is another exception as regards the age at 
which teething begins ; it is often delayed till the tenth 
or twelfth month, and is especially apt to be in the 
scrofulous, rickety and feeble ; it may be in a healthy 



344 HANDBOOK. 

child, and it is not very infrequent either. Some infants 
have teeth cut through at birth. Formerly it was held, 
both by medical men and by mothers, that teething is 
the cause of many ills, such as vomiting, diarrhoea, bron- 
chitis, spasms, convulsions, paralysis, skin diseases, etc. 

Many physicians have " gone back on this doctrine. " 
They admit that considerable swelling and pain in the 
gums, irritability, fretfulness and more or less fever 
often occur, but deny that serious disorders frequently 
result from teething. 

It is the belief of the writer, that, on account of the 
extremely excitable nervous system at this age, convul- 
sions, spasms, vomiting and diarrhoea, in some cases, 
result from difficult teething. 

Formerly the gum lancet was much used in cutting 
the gum over the advancing tooth ; it is not so frequent- 
ly used of late years. One writer curtly says : " Some 
physicians find more use for the gum lancet than for 
common sense. " 

The signs of teething which may be accounted as nat- 
ural are these : a swollen, hot, red and painful condition 
of the gums, and drooling; slight feverishness, with 
flushing of one or both cheeks ; irritabilility of temper, 
with restlessness at night ; carrying the fingers into the 
mouth, and a desire to bite something. These subside 
when the tooth cuts through the gum. 

Treatme?it. If protracted diarrhoea comes on during 
teething, it should be controlled by proper remedies, the 
same as it should be at any other time. The doctrine 



DISEASES OF INFANCY AND CHILDHOOD. 345 

with mothers, that it is not safe to check it, is wrong, 
and may lead to a fatal mistake by the neglect of timely 
and appropriate treatment. If the gums are swollen 
and very painful, dip a small sponge in water as hot as 
can be borne, press it upon the gum for a while, then 
bathe the gum with a mixture of equal parts of pare- 
goric and brandy. It is very seldom that any benefit 
arises from lancing the gum, though we are assured by 
experienced and sensible physicians, that there are cases 
in which it affords great relief to the pain. 

DISEASES AND DISORDERS OF THE STOM- 
ACH AND INTESTINAL CANAL. 

There are no diseases more common, important and 
interesting than those which arise from derangement of 
the alimentary canal — from those organs which take 
part in the digestion and assimilation of food. Proba- 
bly, they form the largest share of the ailments to which 
infants and children are subject. 

Among the varied phenomena which may thus arise, 
which are directly or indirectly dependent upon derange- 
ments of the stomach and bowels in children are these : 
peevishness, restlessness, feverishness, drowsiness, symp- 
toms of brain disease, symptoms of worms, spasms and 
convulsions, night terrors, pallor of the face, loss of flesh 
and strength, skin diseases (humors), canker of the 
mouth, besides the more common symptoms such as 
nausea, vomiting, diarrhoea, constipation, flatulence (gas 



346 



HANDBOOK. 



in the bowels), distress in the stomach, colic, pain in the 
head, back and limbs and a feeling of languor. 

Whenever these symptoms appear, -in an infant or 
young child, an unhealthy condition of the alimentary 
canal may be looked upon as the probable cause, unless 
some other known disease exists, as the original and evi- 
dent cause of the trouble. 

Below, some of the principal diseases of the stomach 
and bowels will be described in detail. 

Indigestion. The stomach, in children, is often re- 
bellious, because often abused. Particularly is this true 
during the first year, in breast-fed as well as in bottle- 
fed children. The restlessness that marks the begin- 
ning is often overlooked, and peevishness is usually the 
first change that draws the mother's attention. 

If she be an observant mother (and let us hope that 
she is), a furred tongue, and probably a sour-smelling 
breath will be noticed. Following these symptoms 
there will be cramps, during which the child will cry 
and draw up its legs. The bowels may be swollen and 
tender, accompanied by belching and passing of wind. 
If the inside of the cheek and lips be examined careful- 
ly, grayish- white nicer-spots may often be seen. The 
same may appear on the tongue, and are usually accom- 
panied by considerable pain. The treatment of these 
spots will be spoken of later on. 

Possibly the first thing noticed will be vomiting. The 
little one may throw up all its food, either the same as 



DISEASES OF INFANCY AND CHILDHOOD. 347 

it was swallowed, or curdled and sour-smelling. Vom- 
iting, however, is not an indication of indigestion alone. 
It may occur, in children, at the commencement of any 
of those diseases which are accompanied by a rash — or 
in fact, almost any acute disease ; yet by careful atten- 
tion to the instruction given in this book, there will be 
little difficulty, usually, in deciding. 

Let us suppose that after careful watching, there is 
reason to believe that the stomach is at fault. We 
should then search for the cause of baby's trouble. If 
it is breast-fed, then you yourselves, mothers are proba- 
bly either working too hard, or eating improper food. 
If it is bottle-fed, then baby's stomach is either over- 
filled, or his food is not of the right kind. Then there 
is the nursing-bottle ; how often is the doctor called, to 
find it sour-smelling and unclean. You should wash it 
after each feeding and place it in cold water until again 
needed. The nipple should be of the variety that fits 
over the neck of the bottle, without a connecting tube. 
The negligence of mothers, in observing even the com- 
mon laws of neatness relating to the nursing-bottle, has 
caused the untimely death of many an infant. 

Then there is frequent feeding. It is not an uncom- 
mon sight, to see a mother crowding the nipple of breast 
or bottle into the little one's mouth, with the evident 
intention of drowning its cries with large draughts of 
milk, every cry being interpreted as a signal for more 
feeding. This is repeated until the stomach is unable 
to do its work, and indigestion is the natural outcome. 



348 HANDBOOK. 

j£very turn that baby makes, or every cry it utters is 
not an indication of hunger. To be sure it takes the 
nipple greedily, but this is because of thirst, resulting 
from the persistent endeavor to quiet it by unnatural 
means. 

Finally, the stomach from sheer exhaustion is unable 
to perform its work, and the nursing is returned in solid 
curds. When it arrives at this stage, the common-sense 
way is, 1st — give the stomach complete rest, and, 2d — 
relieve the thirst. Usually, it is better to stop all nour- 
ishment for a few hours, and to allay the thirst by means 
of Nature's remedy — water, either boiled and cooled, or 
barley-water, if accompanied by diarrhoea, and oatmeal- 
water, if there be constipation. A teaspoonful of either 
may be given every fifteen (15) minutes. After six or 
eight hours of rest, commence nourishment ; a table- 
spoonful at first — either of breast or bottle — and increas- 
ing gradually at regular intervals, until the proper 
quantity is allowed. 

For older children, care in feeding is also necessary. 
What the sour nursing-bottle is to baby, pastry and un- 
ripe fruit is to them. It is not much wonder that John 
spends a restless night, if he is sent to bed soon after a 
hearty meal, with his stomach overcrowded with pie and 
cake. If there be much distress after such a meal, do 
not hesitate to produce vomiting. The best way to do 
this is to give half teaspoonful doses of the syrup of 
Ipecac every fifteen (15) minutes, until the stomach 
empties itself. If you are unable to get Ipecac, warm 



DISEASES OF INFANCY AND CHILDHOOD. 349 

water and salt, or warm mustard water may answer the 
purpose, if freely given. For colic pains, anise cordial 
in doses of from twenty (20) drops to half a teaspoonful 
in hot water, every half hour, will always be useful, and 
hot applications over the stomach should also be made. 
If the pains are not relieved by these measures, Pare- 
goric should be given in a little hot water, one drop be- 
ing allowed for every two months in a year up to the 
first year, and five drops added for each succeeding 
year : for example, to a child three years old, sixteen 
(16) drops may be given every hour till the colic is re- 
lieved. 

For the ulcerated mouth, a wash made by dissolving 
two teaspoonfuls of borax in a half pint of cold water, 
should be frequently applied to the ulcerated spots. 
Never mix honey with borax for a mouth-wash. 

If these measures be faithfully carried out, and no re- 
lief is obtained in a few hours, call your physician by all 
means. 



Indigestion of Older Children. Dr. Meigs, of 
Philadelphia, gives the following excellent description of 
this affection, not well understood, perhaps, by all par- 
ents: 

"Indigestion in children who have completed the first 
dentition [teething] may, as in the case of infants, be 
occasional or habitual. Occasional indigestion occurs in 
strong and vigorous, as well as in more delicate sub- 
jects. The attack generally begins within a few hours 
or a day after the child has eaten some indigestible sub- 



350 HANDBOOK. 

stance, with languor and chilliness in older children, and 
with languor and peevishness in those who are younger ; 
after which there is headache, pain in the stomach in 
most of the cases, and very often a disposition to som- 
nolence. If the child is attacked with vomiting soon 
after the appearance of these symptoms, and ejects the 
offending material, it will often seem perfectly well 
from that time. If, however, this does not take place, 
fever, sometimes of a violent character, is almost certain 
to make its appearance. The pulse becomes very fre- 
quent, rising to 120, 130, or even higher, and being full 
and resisting ; the skin becomes flushed, dry, and very 
hot ; the appearance of the tongue is not generally 
changed early in the attack ; there is considerable 
thirst ; the child is restless and uneasy, tossing from side 
to side, or lies in an uneasy sleep, attended with fre- 
quent starting and jerking of the limbs or crying out ; 
the abdomen is natural, or hard and distended over the 
epigastric region. When the symptoms just described 
make their appearance suddenly, by which I mean in 
the course of a few hours, in a child two, three, four or 
five years old, after it has eaten some indigestible sub- 
stance, there is reason to fear an attack of convulsions. 
The probability of the occurrence of this accident is great 
in proportion to the earliness of the child's age, and the 
impressibility of its nervous system. The attack is par- 
ticularly to be apprehended, and should be carefully 
guarded against, whenever the fever is violent, when 
there are urgent complaints of headache, when the rest- 
lessness and agitation are very great, or when there is 
somnolence, with frequent startings or twitchings of the 
muscles. Convulsions sometimes occur without any 
previous warning, or after such slight signs of disorder 
as would fail to j)roduce uneasiness in the parents or at- 
tendants. 

The symptoms produced by occasional indigestion 
generally continue until nature relieves the stomach by 
vomiting or diarrhoea, or until the remedies proper in 
the case, the most important of which are evacuants, 
have been administered. It happens not unfrequently 



DISEASES OF INFANCY AND CHILDHOOD. 351 

that symptoms of gastric or intestinal disorder remain 
for some days after the violence of the attack has sub- 
sided, and in some instances the disturbance is so great 
as to occasion gastritis, entero- colitis, or dysentery. 

Habitual indigestion in children who have completed 
the first dentition, is not at ail an uncommon affection. 
It is a condition analogous to, if not identical with, the 
dyspepsia of the adult. The symptoms of this form are 
the following. The general appearance of the child is 
delicate, as shown by a pallid or sallow tint of the skin, 
instead of the ruddy complexion of health, by thinness 
and want of proper development of the limbs and trunk, 
and by softness and flaccidity of the muscular tissues. 
There is an habitual air of languor and listlessness, with 
absence of the usual gaiety and disposition to play nat- 
ural to the age, and the child often complains of being 
tired. The appetite is feeble or uncertain, being some- 
times absent and at other times too great; or it is pecu- 
liar, the child being willing to eat of dainties, but refus- 
ing food of a simple character. The tongue presents 
nothing peculiar. It is however more frequently some- 
what furred than clean and natural. The temper is 
usually irritable and uncertain. The child rarely sleeps 
well ; on the contrary, the nights are restless and much 
disturbed, the sleep being broken and interrupted by 
turning and rolling, by moaning or crying out, and by 
grinding of the teeth. These latter symptoms, together 
with the picking at the nose, which is a frequent accom- 
paniment, are almost always referred by the parents and 
nurses to worms, and it is often impossible to convince 
them to the contrary, even though frequent and violent 
doses of vermifuges have failed to show the existence of 
entozoa [worms.] The state of the bowels is uncertain. 
In some instances they are very much constipated, re- 
quiring frequent doses of laxatives, or careful regulation 
of the diet, to keep them soluble ; in others they are in- 
clined to be loose ; in others again, constipation and 
diarrhoea alternate. The abdomen is usually natural, or 
somewhat enlarged from flatulent distention; com- 
plaints of pain are not uncommon." 



352 



HANDBOOK. 



Simple Diarrhoea. Of the ailments of early child- 
hood, looseness of the bowels is very common, especially 
so between the ages of six months and two years. To 
account for this it ma3 r be said that the intestinal glands 
are in a state of active evolution, and that slight irrita- 
tion is sufficient to cause diarrhoea. In many cases the 
diarrhoea is beneficial, as in this way nature removes 
irritating substances from the intestinal tube, but slight 
causes make it pass the limit of health. Atmospheric 
changes have a causative influence, particularly heat and 
cold. A simple diarrhoea in the hot weather would give 
a physician, or an intelligent mother, more uneasiness 
about the result, than it would in the cool months. Ex- 
posure to cold may be the cause of diarrhoea in a child, 
and other causes which would have no effect in the 
adult, induce diarrhoea in the infant. 

Simple diarrhoea sometimes comes on with an attack 
of vomiting; the contents of the stomach being first 
thrown up, afterwards greenish colored mucus, then 
looseness of the bowels follows ; this often happens after 
eating food unsuitable as to quality or quantity. The 
discharges may be bright yellow or greenish in color ; 
white specks are sometimes seen, which are the casein 
of undigested milk. More or less pain, flatulence and a 
feeling of languor may be felt. Diarrhoea of this kind 
is often transient, and yet it may become quite severe 
and persistent, or in beginning this way it may run into a 
severe inflammatory diarrhoea, if it be in the hot months. 
But the latter is only one of the possible results. 



DISEASES OF INFANCY AND CHILDHOOD. 353 

What physicans call severe non-inflammatory diar- 
rhoea may begin suddenly, but more commonly it begins 
as above described and continues for a longer time and 
with much severity ; the child loses flesh rapidly, the 
face becomes very pale, and the features greatly changed. 

Treatment. The mild and transient diarrhoeas of 
children need nothing in the way of medicine to check 
the discharges ; proper restriction of the diet for a few 
days, and, possibly, a laxative, is the best treatment ; in- 
deed in the severe kinds of "summer complaint" parents 
and nurses should be shy in giving medicines to stop the 
discharges, unless they have continued for a long time. 
Too much food is often given to infants ; in some in- 
stances the child gets relief by vomiting, in others the 
excess of food is retained, but is fermented, not digested, 
and this produces an irritation of the intestinal canal, 
and consequent diarrhoea. In hot weather the child is 
thirsty ; pure cold water should be given for drink, in- 
stead of too much milk from the breast or nursing- 
bottle. If much pain attends these attacks of diarrhoea, 
a teaspoonful of the sweet tincture of rhubarb, with a 
a little paregoric, according to the age of the child, may 
be given with benefit. 

Inflammatory Diarrhoea. This is one of the dan- 
gerous diarrhoeal affections of infancy ; it is the great 
destructive summer epidemic of infants living in large 
cities, and less commonly attacks infants who are reared 
in country towns. A brief description of the disease is 



354 HANDBOOK. 

given here that mothers and nurses may have some cor- 
rect understanding of its nature and symptoms, in order 
that skillful assistance may be timely called. 

The disease, which is often a protracted one, may 
have a mild beginning, and not markedly differ in its 
general phenomena — in many of its symptoms, from se- 
vere diarrhoea, not inflammatory, as above described. 
The discharges from the bowels may not, at first, be 
more than four or six a day, and do not much differ in 
appearance from those of ordinary diarrhoea. After a 
few days a new symptom appears — the child begins to 
vomit, and the vomiting continues; the discharges in- 
crease in number, at first being yellowish or greenish, 
afterwards they may be slimy and tinged with a little 
blood; this signifies that the large intestine (the colon) 
has become inflamed, in which case the disease is prop- 
erly called, entero-colitis. In certain cases the dis- 
charges look like spinach or chopped vegetables. There 
is more or less pain in the bowels, and fever. In some 
instances the stools are watery, but less so than in 
cholera infantum. 

In consequence of the continued diarrhoea and vomit- 
ing the little patient becomes greatly changed ; his eyes 
are sunken, his cheeks are hollow, his face is very pale 
and pinched-looking, and the body is greatly emaciated. 
The child, at first, may have been fretful and restless, 
but is now exhausted and remains quiet. In the first 
stages of the disease the child is feverish ; a symptom 
uncommon in ordinary diarrhoea ; another characteristic 



DISEASES OF INFANCY AND CHILDHOOD. 355 

symptom is the marked tenderness of the bowels. Such 
is a brief account of the symptoms of a case of inflam- 
matory diarrhoea. With skillful treatment the patient 
may recover from this perilous attack, if not he gradu- 
ally fails and dies from exhaustion, or from dropsy of 
the brain, or in convulsions. 

Infants from six to twelve months of age are most like- 
ly to suffer from this affection, but those from twelve to 
twenty-f our months are certainly not exempt ; the period 
during which the first teeth are cutting, is that in which 
infants are prone to diarrhoeas. Whether teething is 
the common and real cause, is uncertain. There seem, 
at least, to be other causes, such as improper feeding — 
probably the most frequent one. Bottle-fed infants are 
by far the most subject to such attacks. Unhealthy 
surroundings, in large cities especially, where the air is 
loaded with poisonous germs, no doubt, induce the dis- 
ease in the predisposed, for infants do much better, in 
the hot months, far back in the country where the milk 
and the air are pure. Heat produces decompositions or 
such changes in food that it is probably a causative 
agent in producing diarrhoea, in the infant's sensitive 
condition. Exposure to cold tends to cause a conges- 
tion of the lining membrane of the intestines — the first 
step towards intestinal inflammation and consequent 
diarrhoeas. Some parents allow infants to eat other 
things besides their regular foods. The smallest amount 
of indigestible substances is liable to lead to inflamma- 
tory diarrhoea in some infants. Changing the child's 



356 HANDBOOK. 

milk or food, if bottle-fed, is a dangerous thing to do in 
the hot months. Mothers who nurse their infants 
should be extremely careful of what they eat themselves 
during this season of the year. 

Of course the treatment of this disease, so dangerous 
to the life of the infant, will be left in the hands of a 
competent medical man. Prevention is a very impor- 
tant thing, and much can be done by intelligent mothers 
in this direction by great care in avoiding all the known 
causes, some of which have been here pointed out. 

Cholera Infantum is an infantile disease of the hot 
summer months, especially of July and August. It 
occurs most frequently in infants about six months of 
age. The intense heat of summer and unsuitable food, 
together with a predisposition in infancy to intestinal 
derangements, are the evident common causes. 

In the majority of cases, cholera infantum begins 
abruptly, with persistent vomiting and diarrhoea; excep- 
tionally, it begins in a milder way, that is, it may be 
preceded for a day or two by slight fever, diarrhoea, 
pain in the bowels and loss of appetite. It is said that 
in some cases it follows as a sequel to a protracted in- 
flammatory diarrhoea. In whatever way it may begin, 
the disease when developed is manifested by such well 
marked symptoms, that it is not easily mistaken for any- 
thing else. 

The conspicuous and distinctive symptoms are these : 
the sudden attack; the profuse watery discharges, after 




Dr. Robert Koch. 



Celebrated as an original investigator in the Germ Theory 
of Diseases, particularly as to the Tubercle Bacillus. The 
u Lymph," proposed by him as a cure for Tuberculosis of 
the Lungs (consumption), about which great expectations 
were at one time entertained, even among Learned Doctors, 
was a Failure, showing that there are '* Sensations'' in the 
Medical World. 



DISEASES OF INFANCY AND CHILDHOOD. 357 

the first few — so watery and profuse that they run 
through the diapers and clothing, leaving nothing but a 
greenish stain ; the urgent vomiting, nausea and irrita- 
bility of the stomach, so that cold water is often immedi- 
ately thrown up ; the rapid loss of strength, emaciation 
and change in the appearance of the face, so that in one 
day even the infant would scarcely be recognized ; the 
eyes are sunken and remain half open, and the face is 
deathly pale and cool. No diarrhceal disease of infancy, 
excepting true cholera, brings about such a marked change 
in the features, and in no other disease, excepting cholera, 
are the discharges so profuse and watery. The disease 
runs a rapid course towards death or recovery. Death 
may occur from exhaustion, or from a dropsical effusion 
upon the brain or, possibly, improvement may begin on 
the fourth or fifth day. 

Inflammatory Diarrhoea of Older Children, 

Though diarrhoea as the result of inflammation is a fre- 
quent disease of infancy, as described above, it is un- 
common in children from three and one-half years of 
age upwards. The author has never met with but a few 
cases, and those were chiefly cases following measles. 
Intestinal inflammation at this age when it does occur is 
less extensive than in infancy. The disease may result 
from sudden exposure to cold when the body is heated 
and perspiring, and sometimes from eating unripe or 
stale vegetables. The characteristic symptoms are : pain 
in the bowels and tenderness, diarrhoea, chilly feelings, 



858 HANDBOOK. 

fever, and great loss of strength. At first, usually, the 
nervous system is profoundly disturbed, as shown by 
twitchings of the muscles, headache, drowsiness and 
sometimes by convulsions. If the inflammation is most- 
ly confined to the colon (large intestine), as it sometimes 
is, the discharges, after the first, are scanty and slimy, 
and often a little bloody. These symptoms are suffi- 
cient to distinguish the attack from an ordinary case of 
diarrhoea, which is a very common thing in children, 
and of much less importance. As a measure of pre- 
caution and prevention, in most cases beginning with 
pain and tenderness of the bowels and diarrhoea, it is 
best to give, at first, some mild laxative, such as castor 
oil, the sweet tincture of rhubarb, magnesia, etc., for the 
purpose of clearing the intestines of any irritating sub- 
stances which may be in them ; this treatment is of the 
first importance if the trouble is the result of an error in 
eating. 

Dysentery, which is an inflammation of the lower 
part of the colon and the rectum, is not very uncommon 
in children ; its symptoms are much the same as they 
are in the adult. The beginning is marked by fever, a 
hot and dry skin, chilly sensations, and diarrhoea, after- 
wards a frequent, almost constant desire to go to stool, 
followed by a painful straining sensation ; the discharges 
are peculiar, being scanty, jelly-like masses, mixed with 
blood ; the disease is thus easily recognized. 

A laxative should be first given to clear the intestinal 
canal; afterwards a tablespoonful of thin starch to 



DISEASES OF INFANCY AND CHILDHOOD. 359 

which four drops of laudanum is added should be thrown 
into the rectum, by the use of a small syringe ; this for a 
child four years old ; the laudanum may be increased by 
one drop for every year the child is older. The patient 
must be kept quiet and lying on his back ; only the 
blandest liquid food must be allowed. If the pain and 
discharges continue the injection may be given three or 
four times a day. If laudanum is not at hand, frequent 
injections of warm water may be used. 

Constipation in infants and young children is most 
commonly owing to improper feeding, to imperfect diges- 
tion and to pernicious habits — the habit of allowing the 
bowels to become habitually constipated and then giv- 
ing large doses of j)hysic. Mothers and nurses do not 
always know that acute constipation may produce in a 
young child distress, restlessness, crying and even con- 
vulsions, and that there is a much better and quicker 
cure than to give castor-oil or Castoria. The writer 
once rode a long distance in the night to see a very sick 
child, which sickness was entirely caused by simple, but 
severe acute constipation. By the use of a common 
syringe several injections of warm soapy water were 
thrown into the rectum, producing immediate relief; a 
very simple case which any well-informed mother could 
have cured. If a dose of castor-oil or rhubarb had been 
given, the child might have suffered the remainder of 
the night. 

The following is from a lecture on constipation in 



360 HANDBOOK. 

children by Dr. Rex, of Jefferson College, Philadelphia : 
"I usually give a suppository. The so-called health 
food, or wheat-gluten suppository, not only does good 
at the time, but also produces a permanent beneficial 
effect. Sometimes when the gluten suppository fails, I 
use the glycerine suppository, or, what is still better, a 
glycerine injection, which liquifies the putrid matter 
and produces a satisfactory result. In place of these 
more elegant preparations you may often get quite as 
good effects from the old-fashioned domestic remedies. 
A little piece of Castile soap, cut into the form of a sup- 
pository, is a favorite nursery remedy. If it be dipped 
in sweet oil and put into the rectum with two or three 
rotations, it excites a movement. When necessary, 
this should be done regularly every morning, so that the 
child may learn that the morning hour is the time for 
moving the bowels. * * * * So too you may make a 
suppository from molasses candy which is often success- 
ful. Then, again, you may use liquid injections to over- 
come constipation in childhood. An ounce of a mild 
saline is sufficient for an enema [injection]. If all these 
means fail, what is to be done ? In older children I 
often use senna and fluid extract of rhubarb. Both of 
these drugs act upon the entire intestinal tract." 



DISEASES OF INFANCY AND CHILDHOOD. 361 



WORMS. 

Formerly physicians and medical writers gave a 
greater prominence to worms as a cause of sickness 
than they do at the present time. This explains why 
it is that so many mothers believe in worms ; the notion 
has been handed down through " the tradition of the 
elders." There is sufficient reason for introducing here 
some description of the signs and symptoms upon which 
a reasonable suspicion of a case of worms may be 
founded. 

As a rule, children under three years of age do not 
suffer from worms ; they are most common between the 
ages of three and ten, and in children who are weak 
and sickly, or poorly fed. It is only in extremely rare 
cases that worms get into the stomach or into the throat 
and choke or strangle a child, as mothers think they do. 
In rare cases they may collect in large numbers in balls 
or masses of considerable size in the intestines. 

The five principal kinds of intestinal worms are the 
following : — 

The Hound Worm, the most common kind, resembles 
the common earth worm ; it is round, tapering at both 
ends, smooth and of a whitish or yellowish color, about 
six inches to a foot in length, when fully grown ; the 
head is at the smaller extremity, and when examined 
with a magnifying glass three small horns are seen 
about the mouth. It inhabits the small i irtestines, but 



362 HANDBOOK. 

may get into the stomach by crawling or during vomit- 
ing. Worms may be present in the intestines and not 
give rise to symptoms, but generally some of the follow- 
ing symptoms occur : colicky pains, bloated abdomen, 
loss of appetite, or sometimes precarious or craving 
appetite, offensive breath, nausea and vomiting, diar- 
rhoea, feverishness, and other signs which indicate dis- 
turbed digestion ; paleness about the nose and mouth, 
and a dark ring around the eyes, the lower eyelids 
swollen, grating the teeth in disturbed sleep, waking 
from sleep suddenly as if in pain or frightened, convul- 
sions or spasms, dilated pupils, drowsiness, headache, 
picking the nose and itching at the anus. Now, while 
it is true that worms may be the cause of these symp- 
toms, it is also true that they may arise from simple 
disorders of the stomach and bowels. There is only 
one positive sign of worms — the actual sight of them ; 
other signs are not trustworthy. If there is a suspicion 
of them, some tentative remedies may be given, and the 
stools examined for the presence of worms in them. 

Treatment. Pinkroot is an old remedy for the round 
worms, and is a good one. If }:>arents are inclined to 
give any vermifuge without the advice of a physician, it 
would be much safer and better than many of the worm 
medicines in the market. It acts better when given in 
combination with Senna. The fluid extract of Pinkroot 
and Senna can be bought of any druggist, and may be 
given in teaspoonful doses three times a day, followed 
by a dose of castor oil in the morning. The Oil of 



DISEASES OF INFANCY AND CHILDHOOD. 363 

Wormseed, in doses of five drops three times a day, to 
a child five years old, is a safe and efficient remedy. 

Santonin, which is the extract of the European 
Wormseed, is extensively used by physicians in this 
country and in Europe as a worm destroyer. It is al- 
most tasteless and is therefore easily administered. For 
a child five years old, the dose is three or four grains 
three times a day, for two days, and should be followed 
by a cathartic. 

Pin Worm or Thread Worm is the smallest of the 
intestinal worms, not exceeding one quarter of an inch 
in length. It looks like a short piece of white thread, 
hence its name. 

It inhabits the large intestine, chiefly the rectum, and 
very rarely migrates into the small intestine. They 
frequently exist in immense numbers and give rise to 
symptoms entirely different from those of the round 
worm, for these minute creatures when in the rectum 
cause pain, intense itching, especially at night, and 
sometimes bloody and slimy stools, with painful strain- 
ing. 

Treatment. Injections of salt and water into the rec- 
tum, is one of the best remedies to expel pin worms. 
Why it does not always cure, is because the treatment 
is not continued long enough, or because these lively 
creatures crawl up the bowel beyond the reach of the 
medicine. Quassia- water is a very effective remedy ; 
add one-half ounce of quassia wood to one-half pint cf 
hot water ; after standing in a warm place for a few 



364 HANDBOOK. 

hours, strain off the liquid and use as an injection ; it 
may be repeated if required. 

A worm medicine, swallowed, has but little, if any, 
effect in removing pin worms. 

Long Thread Worm. This worm is an inch or two 
in length, about two-thirds of its anterior part is not 
thicker than a horse-hair, then abruptly the body swells 
into a much larger size. This little thing inhabits the 
upper part of the large intestine, but it is not certainly 
known that it ever gives rise to any disorder of health, 
or to any symptoms. It is more of a curiosity, than of 
practical importance. 

The Common Tapeworm. The tapeworm is a flat, 
jointed worm, generally from five to ten feet long, but 
may be one hundred, according to some writers. The 
segments, or joints, look something like small pumpkin- 
seeds strung together. 

As a rule, only one of these exists at a time in the in- 
testines, and it is not so common in children as in adults. 
Fragments of the worm are passed from time to time, 
otherwise the worm does not always give rise to any 
characteristic symptoms. It is sometimes said that a 
person having a tapeworm has a ravenous appetite ; no 
doubt such is the case sometimes, but not generally. 
Faintness, colicky pains, disturbed digestion, nervous- 
ness, palpitation of the heart, and emaciation are some- 
times noticeable symptoms. 

The most trustworthy symptom of a tapeworm is the 



DISEASES OF INFANCY AND CHILDHOOD. 365 

passage of fragments of the worm, and this usually 
occurs, if a worm is in the intestines. 

Treatment. We quote from Dr. Bartholow : " Pump- 
kin-seed is one of the most efficient remedies which we 
possess against taenia. Two ounces of the fresh seed 
pounded in a mortar, with a half pint of water, until 
the husks are loosened and an emulsion is made. The 
mixture is then strained and the whole amount taken 
fasting : but Squibbs maintains that all should be taken, 
husks included. If an action of the bowels does not 
take place in two hours, the emulsion should be fol- 
lowed by castor-oil. If success is not attained, the dose 
may be repeated every morning until the parasite is 
produced. 

The Broad Tapeworm is very much like the more 
common tapeworm, only its joints or segments are much 
broader ; it produces about the same symptoms and re- 
quires the same treatment. 



366 HANDBOOK. 



ECLAMPSIA. (CONVULSIONS.) 

By this term we mean a convulsive condition of the 
external muscles, which may be partial or general. It is 
recognized by most writers under three distinct forms or 
kinds : — 

1st. Essential, if there is no lesion of the brain or 
spinal cord, or in fact no disease of the body. 

2d. Symptomatic, if there is disease of the brain or 
spinal cord. 

3d. Sympathetic, if it arises from disease elsewhere. 

Eclampsia occurs most frequently in infancy and 
childhood, but is rare after six or seven years of age, 
most common between the ages of three months and 
two years. Convulsions are frequent in certain families, 
and much more frequent in those of an impressible ner- 
vous system. 

The exciting causes are very numerous : diseases of 
the brain, eating indigestible food, changes in the milk 
with which the nursling is fed, eating unripe fruits, etc. 
Some children cannot eat bananas, strawberries or 
oranges, without producing convulsions. In fact, the 
most frequent cause, in the young, is from disorder of 
the alimentary canal. Again, eclampsia occurs as one 
of the initial symptoms of the eruptive fevers, — scarlet 
fever, measles, small-pox and erysipelas, and is liable to 
occur in pneumonia, pleurisy, whooping cough, dysen- 
tery, cholera infantum, etc. Painful teething, worms, 



DISEASES OP INFANCY AND CHILDHOOD. 3G7 

constipation, burns, injuries, fright and anger, may be 
the exciting cause of an attack. 

Eclampsia may be divided into two stages, first, the 
prodromal (forerunning) stage, second, the convulsive. 
In most cases, there is a prodromal stage in which the 
child is inclined to be more or less drowsy, and if dis- 
turbed, fretful ; it starts easily at slight sounds ; the 
whole body may be seen to start violently ; the eyes 
have an unnatural look ; the child cries fretfully, sighs 
and, perhaps, droj^s into a drowsy state again. There 
may be unnatural heat of head, and if the child is old 
enough, he complains of headache. The muscles of the 
face and limbs twitch lightly but rapidly ; the thumbs 
are sometimes involuntarily carried across the palms, 
the eyes half open, the face pale or flushed. These 
symptoms continue from a few moments to several 
hours before the fit, or they may be entirely wanting. 
When the convulsions are about to begin, the child gen- 
erally lies quiet, the eyes are open and fixed, and he 
does not notice or speak. The direction of the eyes is 
then changed, being, generally, turned up under the 
upper lids so that only the whites of the eyes are seen. 

Immediately before the convulsions, the child may 
cry out, then suddenly fall into the spasm. If the con- 
vulsion is general, the child straightens out or bends 
backward, the limbs become rigid, and the features lose 
their natural expression. In this stage the eyes are 
usually open, and the pupils dilated ; the hands tightly 
clinched ; following this is the clonic stage, in which 



368 HANDBOOK. 

the limbs are alternately flexed and extended, the mus- 
cles of the face twitch, and the eyeballs roll, the jaws 
are forcibly closed and the tongue may be bitten. Res- 
piration is greatly disturbed, the pulse is rapid and often 
intermittent; consciousness is completely lost. The 
convulsion lasts from a few seconds to half an hour or 
more, when the child regains consciousness gradually, 
but soon becomes drowsy and finally falls asleep. 

Convulsions occurring at the beginning of the eruptive 
fevers generally subside, but if repeated after the erup- 
tion appears the child generally dies. The prognosis, in 
general, is better if the convulsions are not of great 
length, if the interval between is long, and if conscious- 
ness soon returns. 

Treatment. The child should be placed in a warm 
bath if it can be done, if not, put the feet and legs into 
a pail of warm water to which mustard has been added, 
and apply to the head cloths dipped in cold water. 
This preliminary treatment applies to most cases. But 
in general eclampsia should be treated according to the 
cause, and as with young children it is frequently found 
in the stomach and bowels, an emetic may be given to 
free the stomach and a cathartic to free the bowels of 
the offending contents. 

A teaspoonful or more of the syrup of Ipecac may be 
given to a child one or two years old and repeated in 
fifteen minutes if needed. For older children a tea- 
spoonful of the compound syrup of squills may be given 
with an equal part of the syrup of Ipecac. If these 



DISEASES OP INFANCY AND CHILDHOOD. 309 

syrups are not at hand a little powdered alum given in 
warm water will act well as an emetic. 

The best thing to do generally, when it is desirable to 
secure a prompt action of the bowels, is to give the 
child an injection of warm soapy water, from half a pint 
to a pint, thrown into the rectum, and repeated if need- 
ed. Castor oil may be given if a thorough operation is 
not obtained, or the aromatic syrup of Rhubarb, or some 
other convenient cathartic. This treatment, if the con- 
vulsion is caused by something eaten, is certainly safe, 
and is the jnoper thing to be done at once, and will in 
many cases prevent a return of the convulsion. 

If these measures do not bring prompt relief, medi- 
cines which act on the nervous system are to be given, 
of which the bromide of potassium is the safest and best 
for non-professional persons to handle. Twenty grains 
may be dissolved in eight teaspoonfuls of sweetened 
water and one teaspoonful given every ten or fifteen 
minutes to a child one year old, twice the quantity to 
one two or three years old, till the convulsions cease. 

If the convulsion arises at the commencement, or in 
the course of cholera infantum, inflammation of the 
bowels, or dysentery, a warm flaxseed poultice, to which 
a little mustard has been added, should be placed upon 
the bowels. When pain is a jn-ominent symptom in 
these attacks, it is probably true that a few doses of 
paregoric may prevent a recurrence of the convulsion, 
through its soothing effect upon the nervous centers. 



370 



HANDBOOK. 



Partial Convulsions, usually called, spasms, are more 
common, perhaj)s, than general convulsions, the form 
which has been above described. In this kind or vari- 
ety, the muscles of the eyes and face, one or both ex- 
tremities, and other muscles and parts of the body, are 
seized with spasmodic movements, or contractions more 
or less severe. " Inward fits " and " Nine-day-fits " are 
examples of partial convulsions. For a description of 
the latter, see page 62 ; and " Child Crowing, " page 63. 
For a description of general convulsions, by another 
writer, see page 63. 



DISEASES OF INFANCY AND CHILDHOOD. 371 



DISEASES OF THE RESPIRATORY ORGANS. 

Next to the ailments which take their origin from 
disorders of the alimentary canal — the mouth, stomach, 
and intestinal tube, the most common are those of the 
air passages, or respiratory organs, from which we have 
catarrhs, coughs and colds, bronchitis, pneumonia, etc. 
A description of these affections, by different authors, is 
here given. 

Bronchial Affections of Children. The bronchial 
tubes or air-pipes convey air to the lungs, to feed the 
blood with oxygen. They are two in number, and lead 
from the windpipe or trachea into the lungs, where they 
split up into smaller and smaller branches. The left is 
nearly twice as long as the right, but it is not so large ; 
consequently, foreign bodies accidentally entering the 
windpipe are more likely to fall into the right tube. 
When a child has been exposed to cold, damp air, smoke, 
irritating vapors, damp bed, etc., congestion ensues, 
which soon passes on into inflammation. The tube- 
walls are then red, hot, swollen, and weeping ; the free 
passage of air, at first only impeded, is soon gravely 
obstructed; carbonic acid accumulates in the blood; 
and nature strives to clear the way by setting up a har- 
assing cough, in order to promote expulsion of the 
glairy mucus or prevalent secretion. There is chilli- 
ness, a stuffy feeling of oppression in the chest, rapid 



372 HANDBOOK. 

breathing, high temperature (fever), headache, quick 
pulse, and furred tongue ; and in bad cases, the sides of 
the nose work convulsively. The child undoubtedly 
has bronchitis. If the trouble is situate in the two 
upper or larger tubes that emerge from the windpipe, 
the case is less urgent, but when the smaller subdivisions 
are affected, closer to the lungs, the outlook will be 
more serious, as capillary bronchitis is prone to end in 
broncho-pneumonia, or perhaps in collapse of the lung. 
It also involves still greater difficulty in breathing, some- 
times threatening suffocation ; and the child may become 
fatally prostrated, or die in delirium or coma ; for the 
calibre of the capillary tubes is narrowed more appre- 
ciably than that of the larger, and the danger is pro- 
portionately greater. Bronchitis in infancy and child- 
hood is always a formidable disease, and calls for the 
earliest attention. Its symptoms are palpable, and not 
easily mistaken ; and an intelligent parent or guardian 
has little excuse for neglect. Immediately that a child 
developes some or all of the foregoing symptoms, after 
exposure, it should be put to rest in a blanket bed, in a 
warm, equal temperature, constantly moistened by steam. 
This is easily secured by means of a steam kettle, or jugs 
of boiling water ; and it is well to administer a mustard 
or ipecac emetic, at the onset. This may be repeated as 
occasion arises, or whenever the tubes are so clogged with 
mucus as to prevent sleep. A tablespoonful of mustard 
in a bath of hot water is frequently of much benefit. A 
jacket-poultice of flaxseed may be made to encompass 



DISEASES OF INFANCY AND CHILDHOOD. 373 

the entire chest, or equal parts of mustard and flaxseed 
may be applied to the front. Sometimes turpentine on 
flannel or croton-oil liniment are used. Warm demulcent 
drinks, such as barley-water or flaxseed tea, should be 
given ; and much relief often follows the administration 
of frequent small doses of ipecacuanha. Half a tea- 
spoonful of the wine may be added to eight tablespoon- 
fuls of sugared water, and a teaspoonful of this given 
every two or three hours, to a child under Ave years of 
age. If carbonate of ammonia or chlorate of potash are 
at hand, one or two grains of either or both may also 
be given in water every three or four hours. Some of 
the above simple remedies are to be found in every 
household ; and a clinical thermometer is a most valua- 
ble investment, especially in country residences. At 
the commencement of illness, the parent should ascer- 
tain the temperature, and watch its rise. Should it 
register 101° or 102°, and either remain there or 
mount still higher, medical aid should be sought. Three 
minutes under the tongue, or five minutes under the 
arm will give reliable indications. The above treat- 
ment includes about as much as the mother can safely 
employ before the doctor comes ; but she is not justified 
in administering the stronger agents that may be called 
for by the growing exigencies of the case. 

Capillary Broncnitis affects the ultimate ramifica- 
tions of the bronchial tubes, where they enter the vesi- 
cles of the lungs ; and, as before stated, is more dan- 



374 HANDBOOK. 

gerous, because the swollen lining of the tube-walls 
more completely obstructs the passage of air, and invites 
emphysema and pulmonary collapse. The countenance 
is dusky and fearsome, and the veins are prominent on 
the surface. The breathing is very much hurried, and 
out of all proportion to the pulse, and the chest and 
belly are drawn inward with each inspiration in severe 
cases; cough is incessant, and expectoration difficult. 
The temperature runs high, the urine is diminished ; and 
increasing prostration or general dropsy may usher in 
delirium, coma, or death. In this form of bronchitis, 
steam should be persistently used, and emetics and all 
lowering means employed with caution ; but a blister is 
often of signal benefit, when the fever is excessive, and 
the respiration greatly obstructed. Or dry wrapping 
over the chest may be tried. Most of these cases call 
for stimulants and supporting treatment ; and opium is 
best left severely alone. As for diet, it should be nutri- 
tious, as hot thickened soups, eggs, arrowroot, and 
custard, administered little and often. Capillary Bron- 
chitis often merges into Catarrhal Pneumonia, by ex- 
tension of inflammation into the lung tissues. This 
disease occurs in children as an acute affection, whereas 
in adults, it is generally chronic, supervening on an at- 
tack of chronic bronchitis. The pulse and temperature 
rise at the same time ; breathing is urgently impeded, 
but expectoration diminishes, and the cough becomes 
hacking and painful. The child may now become 
comatose. Hot moist poultices, and about twenty drops 



DISEASES OF INFANCY AND CHILDHOOD 375 

of brandy every two or thrre hours, are indicated ; but 
the doctor must be called as soon as possible. 

Acute Croupous Pneumonia is an inflammation 
of lung tissue with exudation of fibrine into the air-cells. 
It commonly arises from cold or sudden chill when the 
body is heated ; hence it often makes a sad ending to a 
children's party. It has three stages, those of engorge- 
ment, red and gray hepatisation. It usually attacks 
one lung, in its lower part, but may involve the whole 
of one or both ; and it is either heralded by a chill and 
rapid rise of temperature, or the chill may be replaced 
by vomiting or convulsions. There is a stabbing pain 
at the affected spot, increased by movement or deep 
breathing ; dyspnoea, and a restrained cough, held back 
on account of the pain it produces, and soon a viscid 
expectoration, with a rusty or brick-dust tinge. The 
surface is dry and burning ; the pulse rapid and full at 
first, but later on it weakens. The cheeks are marked 
by circumscribed redness, the lips bluish, and often 
eruptive. Headache, coated tongue, lost appetite, and 
increased thirst supply the remaining prominent symp- 
toms. In favorable cases, these signs abate in about a 
week; otherwise death may occur from sheer exhaus- 
tion. Similar initial treatment to that recommended for 
bronchitis may be adopted ; but this disease needs' early 
professional attention. Of course, for the physician, the 
physical signs of the above-mentioned diseases have the 
greatest interest ; but they have been purposely omitted 



376 HANDBOOK. 

for obvious reasons ; and parents will have done all that 
lays in their j)rovince, if they intelligently use the sim- 
ple remedies here suggested, and bear in mind that heat 
and moisture are the main domestic helps to the ob- 
structed breathing. 

Pleurisy and Pneumonia. (See also description of 
jnieumonia above by another writer.) Pleurisy, as an in- 
dependent affection, is rare in a child under live years of 
age ; it is not at all likely that the reader will ever meet 
a case at this age, but the affection is quite common as 
accompanying pneumonia. Older children, however, 
sometimes have pleurisy from exposure to cold. The 
prominent symptoms of acute pleurisy are, a stitch pain 
in the side, felt particularly when the patient coughs or 
takes a long breath ; a dry cough, slight fever and rapid 
breathing, and more or less tenderness of the side on 
pressure. A mustard draught should be applied to the 
side and several doses of tincture of aconite given to 
produce perspiration. 

Pneumonia, which is the same thing as " lung fever ", 
is an inflammation of some part of the lung substance. 
It is a disease not of easy recognition in a young child- 
It occurs in two principal ways, that is, it may be either 
a primary or a secondary disease. By a primary disease 
is meant, one beginning independently of another dis- 
ease, by secondary, one that attends some other disease, 
or is a complication of it. Primary pneumonia, in in- 
fancy, is a rare thing, the secondary form is not uncom- 



DISEASES OF INFANCY AND CHILDHOOD. 377 

mon, as attending bronchitis, measles, whooping cough, 
etc. Primary pneumonia, when it does occur, is apt to 
be mistaken for pleurisy, bronchitis, an essential fever, 
scarlet fever, intermittent fever, brain fever (menin- 
gitis), etc. 

The characteristic symptoms of pneumonia are: a 
high fever, a flushed face, full and rapid pulse, hurried 
breathing and expiratory moan (a little grunting sound 
with each breath), an expression of the face indicative 
of suffering, a cough and often a stitch pain in the 
side, due to the co-existing pleurisy. Coughing seems 
to be painful. If the pneumonia is secondary, as it is 
much more likely to be, the symptoms will be mixed 
with those of the primary disease, and in many instances 
the former disease is not recognized. If in the course 
of bronchitis, measles, whooping cough, etc., the patient 
seems to get worse without a well understood cause, 
pneumonia should be thought of as the possible cause. 
In favorable cases pneumonia in children runs its course 
in a week or ten days ; the breathing becomes less 
oppressive, the fever subsides, the expression of the 
face is better, and health rapidly returns. In the pre- 
ceding article on "Bronchial Affections in Children," 
pneumonia is explained as a complication of bronchitis. 
Of course the treatment of pneumonia should, in all 
cases if possible, be left to the hands of a skillful physi- 
cian. It is here briefly described, that any intelligent 
parent may have some correct knowledge of its symp- 
toms and manner of attack. 



378 



HANDBOOK. 



Croup. There are three varieties of croup, namely: 

1st, the mild form. This, properly speaking, is false, 
or spasmodic croup. 

2d, the severe form, which much resembles true 
croup, but differs from it in not having the false mem- 
brane, and is also spasmodic croup. 

3d, the true or membranous croup, which is most 
dangerous, and often proves fatal. 

1. The first variety, simple spasmodic croup, is not 
a dangerous disease. It is generally the result of a 
cold, or it may arise from indigestion, or long con- 
tinued crying. It generally occurs in cold or damp 
weather. The child goes to bed apparently in good 
health, but is suddenly, usually after midnight, awaked 
by a peculiar barking, or crowing eough, and more or 
less difficulty of breathing. At first the face may be 
flushed, but soon it becomes purple, and finally the 
child becomes deathly pale, and coughs in the peculiar 
manner above referred to. One cannot very well mis- 
take the disease. Weak and strong children alike are 
liable to the attack. 

There may, or there may not be some slight inflam- 
mation of the lining of the larynx [windpipe], which 
causes the spasmodic action, the cough and other symp- 
toms. This mild form is next to never fatal, and the 
application of a few simple remedies will soon relieve 
the patient, and there is no further danger, except that 
children are liable to be attacked again, at some future 
time. The disease is so common here, [Philadelphia] 



DISEASES OF INFANCY AND CHILDHOOD. 379 

that nearly all mothers who have small children know 
how to manage it, and keep on hand the remedies best 
suited to it. It seldom occurs in children under one or 
over ten years, and is most frequent between the ages 
of two and five years. After the first attack meas- 
ures are to be taken to prevent another during the 
second and third nights. During the day the child 
appears to be quite well, except a slight cough and 
hoarseness. 

2. The severe form of false or spasmodic croup dif- 
fers little from the foregoing, except that the spasms, or 
fits of coughing continue much longer, and come on at 
shorter intervals. It may be a continuation of the mild 
form, growing worse. The child is, generally, taken be- 
fore midnight with the first attack of the severe form, and 
is apt to have another towards morning, before daylight. 
The extent of the inflammation in the larynx is much 
greater than in the first, and unless vigorous measures 
are resorted to this form may prove fatal. This variety 
is sometimes difficult to distinguish from true membran- 
ous croup, except that there is no false membrane, though 
all the other symptoms are apparently the same. There 
is fever, suffocation threatens, the voice is lost in a 
mere whisper, or is altogether inaudible. The face is 
pale and deathlike, the child becomes delirious and falls 
into a stupor, and death occurs by slow asphyxia. Here 
much depends on the treatment which is more closely 
allied to the treatment of true croup. It takes longer 
to get over this, than over the mild variety of the dis- 



380 HANDBOOK. 

ease. The little patient may be from six to eight days 
until he has entirely recovered. 

3. The third variety is true croup, or membranous 
croup. This is a most dangerous affection. It comes on 
slowly, not like the others. The child has fever and a 
hoarse croupy cough, and shows signs of having a bad 
cold. The hoarseness increases as the disease advances 
from day to day. The voice after a time is changed to 
a whisper or becomes altogether inaudible. The cough 
becomes suppressed, and the child struggles for breath, 
tears at its throat, until it becomes unconscious and 
death closes the scene. All this is owing to a deposit 
of false membrane along the lining of the larynx, or 
windpipe. The child's only salvation is the loosening 
and expulsion of this false membrane. If the child re- 
covers, the hoarseness continues for several weeks. 
The severe form of spasmodic croup only continues for 
a few days, seldom more than three or four days. 

In the first two varieties after the paroxysm the child 
seems well, has no fever, or very little. The voice is 
but slightly hoarse or perfectly natural, and not whis- 
pering. If the paroxysm returns the second night, in 
false croup, it is less severe. The cough becomes loose 
and the hoarseness disappears. This is not the case with 
true croup, in which the hoarseness and dryness of the 
cough increase from day to day, until the cough becomes 
almost entirely suppressed, and the hoarseness is changed 
into a whisper, and the voice is lost. 

Let mothers remember that when their child wakes 



DISEASES OF INFANCY AND CHILDHOOD. 381 

in the night with this peculiar cough, somewhat resem- 
bling the barking of a dog or the crowing of a chicken, 
and with the difficulty of breathing above referred to, 
that the child has the croup, probably spasmodic croup. 

Treatment. The first remedy to be tried is hot 
water. Give the child a few tablespoonfuls as hot as it 
can drink, and use cloths wrung out of hot water 
wrapped about the neck ; and a warm bath, for ten or 
twenty minutes. This will, generally, relieve the spasm. 
Wrap the child in a warm blanket, as soon as taken out 
of the bath, dry the skin by rubbing it gently, and put 
the child to bed. It will soon go to sleep, and will not 
be disturbed for the rest of the night. 

One remedy which I have always used with best re- 
sults is the Syrup of Garlic. If there is much difficulty 
in breathing, I give a teaspoonful at once, and in ten 
minutes another, if required. This will, generally, re- 
lieve without resorting to the bath. This remedy should 
be kept on hand in every house where there are children. 
The Syrup of Squills, one-half teaspoonful, and in ten 
minutes another, will act well. A little ]}aregoric, three 
to five drops, may be added to each dose of the Syrup 
of Squills ; or twenty drops of the Compound Syrup of 
Squills may be used. If these remedies fail to relieve, 
which they seldom do, then an alum emetic will be best. 
Take one heaped teaspoonful of powdered alum, and 
mix with about two tablespoonfuls of molasses or honey, 
or what is still better Syrup of Ipecac. Mix well, and 
give a teaspoonful of this to the child every five or ten 



382 HANDBOOK. 

minutes, in a little lukewarm water, until the child vom- 
its thoroughly. The alum emetic is perfectly harmless, 
and in this disease is highly beneficial, and effective. 
After the child has vomited, give the Syrup of Garlic, 
or squills and paregoric. A few doses of any one of 
these remedies must be given during the following day, 
and before the child retires on the following night, to 
prevent a second attack. A dose of magnesia will be 
required on the following day, one-half teaspoonful, in 
milk, will be sufficient. I prefer magnesia to castor oil, 
though castor oil may be used instead, or the Syrup of 
Rhubarb. In the mild form this is all that will be re- 
quired, and the child will get well. 

In the severe form of false croup it is best to begin 
with the alum emetic at once, and the warm bath. This 
should be followed by Syrup of Squills or Garlic, with a 
little paregoric added. One or two drachms of pare- 
goric and one and a half ounce each of Syrup of Squills 
and Garlic, given during the day at intervals of from 
three to four hours, dose, one teaspoonful to a child five 
years old. A little of the Syrup of Ipecac may be add- 
ed. All these remedies make the cough moist and loose, 
and prevent a return of the spasm of croup. If noth- 
ing else is at hand, the Syrup of Ipecac may be given 
at first _and in one or two teaspoonful doses, till free 
vomiting is produced. 

Hive Syrup may be used alone ; it should be kept on 
hand in every family where there are small children. 
In this disease it will be found a most useful remedy. 



DISEASES OF INFANCY AND CHILDHOOD. 383 

A tea made of flaxseed, slippery elm, or seneca snake 
root, properly sweetened, and a slice of lemon added, 
will be found useful as a drink during the day, in addi- 
tion to the other remedies. During the treatment, and 
for a few days after the first paroxysm, keep the child 
in a warm room, and under no circumstances expose it 
to a cold blast of air. The diet must be of easy diges- 
tion and simple. 

No treatment for membranous croup will be suggest- 
ed, as there will be time to call in a skillful j)hysician, 
who will be needed to manage this formidable disease, 
unlike that of spasmodic croup, often successfully treat- 
ed by intelligent mothers. 



3S4 HANDBOOK. 

THE CONTAGIOUS DISEASES. 

Measles. This disease is the most common of the 
so called children's diseases, though neither age nor sex 
is exempt from it. As one attack is all a person has, 
far more children than adults suffer from it. In the 
great majority of cases it affects the mucous membranes 
of the eyes, nose, throat and lungs, and the skin. The 
nature of the contagion is unknown, but there is no 
doubt it is developed in the air passages of the nose, 
throat and lungs, and is transmitted in most cases by 
the breath, hence at short distances ; more rarely it is 
by the clothing, and mucus from the nose and throat, 
but this is very unusual. The time for the develop- 
ment of the disease is about eight days after exposure, 
when there begins to be a harsh, dry cough, with some 
rawness of the throat, followed by a watery condition 
of the eyes, and a watery discharge from the nose. 
About this time the characteristic red spots in the back 
part of the roof of the mouth can be plainly seen. This 
stage of the disease lasts, as a rule, about four days, 
though in severe forms it may two or three days longer. 
Then the eruption begins to appear on the forehead 
and face, and gradually extends over the neck, body 
and limbs. The time required for this varies, at times 
spreading over the whole surface in a few hours, but as 
a rule, two days from the time the first spots appear the 
whole surface of the body is covered. 

The eruption is unlike any other, when fully devel- 



DISEASES OF INFANCY AND CHILDHOOD. 385 

oped. At the very first there is a similarity to the 
eruption of scarlet fever and German measles. In 
measles, the beginning of the eruption is in fine points of 
a dark red color. The points or spots in twelve to 
twenty-four hours unite in little half moon shajoed 
patches which are raised slightly above the surrounding 
skm — the skin between them being natural. No mat- 
ter how numerous the patches are the skin between 
them is natural. The eruption of scarlet fever is bright 
red as its name indicates. German measles has reddish 
spots, but not the other symptoms mentioned — and has 
no relation to measles. 

If the patient, whether child or adult, begins to have 
a cough, dry and harsh, the eyes red and watery and a 
watery discharge from the nose, also a mottled appear- 
ance of the roof of the mouth you may be sure measles 
are developing. There is no other disease which attacks 
in this way. Hay fever or influenza has a watery dis- 
charge from the eyes and nose, and rawness of the 
throat, but the throat does not have the mottled appear- 
ance. Another symptom which should be mentioned is 
the odor of the patient. It cannot be described but it 
is known as the " measley smell," and once experienced 
will be readily recognized. Nursing babes as a rule are 
exempt from measles. 

The duration of the disease varies, but in uncompli- 
cated cases of average severity, the time from exposure 
to completion of the eruption is fourteen days, and from 
the eruption to its disappearance, six to seven days. 



386 



HANDBOOK. 



This in most cases is followed by a fine scaly or branny 
desquamation, lasting four or more days. The above is 
a description of a case of measles running a natural 
course in a patient usually in good health. 

The treatment of measles ordinarily is very little, as 
the disease runs a stated course. The patient should be 
kept in a well ventilated darkened room, at a tempera- 
ture from 65 to 68 degrees, and the bedclothes not 
enough to give discomfort by their weight or warmth. 
Keeping a patient in a profuse perspiration is injurious, 
as it is very debilitating, and the patient is far more lia- 
ble to be injuriously affected by a draught of air. 

The fever which accompanies the disease needs little, 
if any treatment, as it will not diminish until the erup- 
tion is well developed. Usually the temperature is the 
highest immediately preceding, and for the first twenty- 
four hours after its appearance. On the second day of 
the eruption the severe synrptoms begin to abate. Five 
drops of tincture of aconite in a tumbler of water, a 
teaspoonful every hour until there is a moisture on the 
skin is sometimes beneficial. For the thirst, water — 
not ice water— may be freely given in small quantities. 

The most troublesome of all the symptoms is the har- 
assing cough. The cough syrups, so commonly given 
to loosen it, are of no benefit, as there is no mucus to 
raise. Three to five drops of tincture of belladonna, in 
a tumbler of water, a teaspoonful of which may be 
given every half hour to two hours, according to the 
severity of the cough, often alleviates. If the cough 



DISEASES OF INFANCY AND CHILDHOOD. 387 

continues after the eruption is well developed, a physi- 
cian should be called, as one of the most dangerous 
complications is pneumonia, which no one but a physician 
should attempt to treat. During the coughing stages 
gum Arabic water, by its soothing, properties, makes an 
excellent drink. Flaxseed tea so common in the country 
makes a good drink. Often the eruption is delayed, and 
in such cases, baths of hot mustard water will often 
cause it to appear. Warm or hot lemonade is also very 
useful. The nauseous and often filthy teas, so often 
given are worse than useless. Do not worry because 
the eruption does not appear as soon as you think it 
ought, sooner or later it will come out. After the erup- 
tion appears, keep the patient comfortable, and let the 
disease take its course. Pneumonia as a complication 
has been mentioned, another complication not so dan- 
gerous as pneumonia, is a profuse, watery diarrhcea. 
A physician alone should be allowed to treat this. 

Diet. As a rule during the first stage, the patients 
have very little appetite; if so, do not urge food upon 
them. The food should be light and nutritious, such as 
the various kinds of gruel, boiled rice, toast and weak 
tea. Milk is both food and drink, and if relished by the 
patient, is usually well borne. After the fever begins 
to lessen, meat broths, oysters, baked, not boiled pota- 
toes, may be given with safety, and as convalescence 
progresses the usual diet may be resumed. The patient 
should avoid undue exposure to cold for several weeks 
after the attack. 



388 HANDBOOK. 

SCARLET FEVER. 

Scarlet fever, scarletina, scarlet rash, canker and rash, 
are different names for one and the same disease. This 
eruptive contagious fever is one of the most dreaded 
diseases of childhood. It was formerly considered a 
variety of measles, till its prevalence in London from 
the year 1661 to 1665, when the disease was care- 
fully studied and thereafter considered an entirely dif- 
ferent and distinct affection. It is a very contagious dis- 
ease, but the nature of the contagion is unknown. No 
age is exempt, but it is extremely rare in infants less than 
one year old, and quite rare in adults. Children between 
two and seven years are the most susceptible to it. If 
a child can escape the disease till after his tenth or 
twelfth year, his chances of evading the contagion are 
greater, and the danger of the disease if contracted is 
lessened. The period of incubation, that is, the time be- 
tween exposure and attack, varies ; in the majority of 
cases it is from four to seven days. The regular form 
of scarlet fever may be preceded for a day or two by 
slight languor and loss of appetite, but usually the dis- 
ease begins abruptly, with high fever, chilly sensations, 
vomiting, sore throat, frequent pulse (130 to 140) and 
thirst. Less commonly convulsions, delirium or stupor, 
and persistent vomiting are early symptoms. The re- 
markable and distinctive phenomena about the attack 
before the eruption are : the sudden onset from appar- 
ent good health, the high fever, the vomiting and the 



DISEASES OF INFANCY AND CHILDHOOD. 389 

sore throat. These things of themselves should create 
a strong suspicion of the nature of the coming disease, 
if the child has not previously had scarlet fever. 

If the sore throat is examined at this early stage it 
will be found covered with a scarlet efflorescence, which 
as a rule, appears here before it does on the skin. 
When the sickness has continued about twenty-four 
hours, it may be less or more, another highly significant 
symptom is added, namely, the eruption, and it puts a 
distinguishing mark upon the disease, as in no other 
eruptive fever does an eruption appear so early, except 
Rotheln. The rash is usually first seen on the sides of 
the face or neck, and front of the chest; it rapidly 
spreads over the whole body, being more intense on the 
chest, where it acquires, on the second day, the bright 
red or scarlet color, which gives the name to the disease. 
The eruption when well out looks the same as if the skin 
had been reddened by a mustard plaster in patches of ir- 
regular shape and size ; these patches soon run together, 
and give to a large portion of the skin the appearance 
of uniform, smooth, flat and scarlet redness. The tongue, 
which is at first furred white, has a peculiar appearance 
when the coat comes off ; it is then called the " straw- 
berry tongue. " The rash sometimes recedes to appear 
again. When the inflammation of the skin is quite 
intense, small water blisters (vesicles) may be noticed. 
On the fourth or fifth day the redness begins to fade, 
and on the seventh the epidermis begins to come off 
in scales, called desquamation. This is the regular or 



390 HANDBOOK. 

typical form, but cases very different are often seen. 

The disease sometimes runs a mild course, with slight 
or indistinct eruption and moderate fever. In some in- 
stances the affection seems to be confined to the throat 
mostly, with pain and stiffness of the neck and much 
swelling of the glands of the neck. There may be 
patches of canker upon the throat from which fact the 
disease was formerly called " Canker and Rash." There 
may be symptoms of croup — a true membrane some- 
times forms, which is diphtheretic. In nearly all epi- 
demics of scarlet fever irregular forms occur. The 
disease is generally milder, or runs a more favorable 
course when the epidemic is declining, than it does on 
its first appearance in a community. Scarlet fever has 
many complications and sequels, such as disease of the 
kidneys attended with dropsy and blood poisoning, 
abscesses in the ear and about the neck, rheumatism, 
pleurisy, etc. The malignant form begins with severe 
symptoms, such as persistent vomiting, intense headache, 
delirium or convulsions, high fever, great restlessness or 
in some cases, coma, and it is evident to all observers 
from the first, that the child is dangerously ill. 

In so called Scarlatina Anginosa, the disease is chief- 
ly confined to the throat, which is greatly inflamed. The 
rash may not appear till the third or fourth day, and in 
some cases it may not appear at all. 

Different epidemics differ very much in severity ; in 
some the disease runs a mild course, and nearly all chil- 
dren who are attacked recover ; in other epidemics the 



DISEASES OF INFANCY AND CHILDHOOD. 391 

disease is severe, and fatal in many instances. There 
are some affections which may be mistaken for scarlet 
fever, namely, measles, German measles, rose rash, and 
erythema. A description of these latter affections may 
be found in preceding pages, and a table, showing some 
points of difference between scarlet fever and German 
measles, may be found on page 395. 

Some points of dissimilarity between measles and 
scarlet fever are as follows : 

MEASLES. SCARLET FEVER. 

Begins with symptoms of a cold No symptoms of this kind, 

in the head, sneezing, watery and 
inflamed eyes, etc. 

A dry, harsh cough. No cough except in rare cases. 

No vomiting. Vomiting a very common initial 

symptom. 

Rash appears from the third to Rash appears, at the end of the 

fifth day of fever. first day of fever, sometimes earlier, 

sometimes later. 

Rash is darkish rose colored, and Rash is flat and bright red, like 

in blotches slightly raised. that made by a mustard plaster. 

Rash appears first on the soft pal- Rash appears in throat early, 

ate and roof of mouth, second or 
third day. 

Tongue simply coated or red. Tongue at first coated white, af- 

terwards, " strawberry tongue." 

It should be borne in mind that in the above table 
reference is made to the regular form of these fevers ; 
in the irregular forms these points oi distinction might 
not be found. 

Treatment. If a child is suspected of having scarlet 
fever, and if there are other children in the house, the 
sick child should be at once separated from them, and 
all reasonable precautions taken to prevent the sj^read 
of the contagion. A physician should be called at once. 



392 HANDBOOK. 

Domestic medicines have but little effect if any in con- 
trolling the disease, besides dangerous complications are 
liable to arise, which call for skillful treatment. 

In the way of nursing, cooling drinks, like lemonade, 
may be allowed, and in the early stages, when the skin 
is hot and dry, and the pulse full and strong, a cooling 
sponge bath of bay rum, or alcohol and water, is grate- 
ful to the patient and is beneficial. 

In the stage of desquamation, that is, when the epi- 
dermis, or outer skin is coming off, great care should be 
taken in preventing exposure to cold and dampness, and 
even for a few weeks thereafter, for acute Bright's dis- 
ease, attended with dropsy, is often caused by such 
exposure. Very great care is needed to prevent this 
common and dangerous complication. 

To prevent the itching and burning feeling the skin 
should be smeared with vasaline or some other agreea- 
ble oily substance, and it is said that this prevents the 
spread of the contagion. 

The following directions for fumigating a room after 
scarlet fever or diphtheria comes from the New York 
City Board of Health : 

" The windows antl doors of the room and fireplace should 
be tightly closed. Everything that was in the room during 
sickness should be left in it. If the carpet was not removed 
when sickness commenced, it should be taken up and raised 
as far as possible from the floor, on chairs or in any other 
manner ; one board of the floor should be taken up. An iron 
kettle should then be placed on the floor, on bricks, and five 
pounds of sulphur placed therein, or one pound of sulphur 
for each thousand cubic feet to be fumigated; upon this two 
ounces of alcohol are poured and set on fire. Every one must 
withdraw from the room immediately, as the fumes are pois- 



DISEASES OF INFANCY AND CHILDHOOD. 393 

onous. The precautions taken with the carpet, and the re- 
moval of the board from the floor, allow the fumes of the 
burning sulphur to pass beneath the floor and between the 
walls, and to destroy any germs of disease which may be 
there. At the expiration of ten (10) hours, not before the 
room may be opened. All the windows, doors, and the fire- 
place should remain open for twenty-four hours, that every- 
thing may be well aired. " 



German Measles. (Rotheln, False Measles.) Ger- 
man measles is an eruptive, contagious disease of mild 
character, attended with slight fever and with other 
symptoms which resemble those of true measles and 
scarlet fever. Rotheln is the German name. The af- 
fection is interesting and important, chiefly on account 
of its likeness to the above named diseases. It is, as far 
as being recognized as a distinct disease, a new one ; for 
it was formerly supposed to be a hybrid of measles and 
scarlet fever. It is classed as one of the diseases of 
childhood, but it occurs in adults, though rarely after 40 
years of age. Sucklings and young infants, as a rule, 
do not take the disease. 

In some instances the first thing to call attention to 
the existence of the disease, is the eruption on the skin, 
in other cases certain so called prodromes manifest 
themselves before the rash appears, such as sneezing, 
running from the nose and eyes, slight cough and more 
or less fever. The rash may come out on the first day, 
or not till the second, third, or even the fifth, being re- 
markably irregular in this respect. In the majority of 
cases it appears the first day of illness, and consists of 
small slightly raised red spots on the skin, varying in 



394 HANDBOOK. 

size from the head of a pin to a split pea ; they may be 
so minute that the skin appears covered with innumera- 
ble fine dots. If the skin is examined carefully it will 
be found of a healthy color between these points of 
eruption; the spots may, however, run together and 
thus form large patches of uniform redness, not easily 
distinguished from those of scarlet fever. It is said that 
the rash is sometimes brown in color. The disease is 
often very mild, the child being able to be around as 
usual ; in other cases considerable illness is felt. It is 
only the mild forms of true measles and scarletina that 
can be mistaken for German measles. The affection is 
more common in England, and on the continent, than in 
this country. We quote from an English writer a short 
description of the disease : " Slight fullness of head, 
heaviness, pain, or giddiness is felt, with aching of the 
back and limbs, and a little tenderness of the throat, for 
twelve hours or a day before the rash appears: very 
often the rash is seen with surprise, as the feeling of 
illness has passed, or may have escaped notice. Some 
enlargement of the glands of the neck is an early sign, 
most marked in children. There is redness of the 
fauces [throat], less mottled than in measles, not so in- 
tense as in scarlet fever ; the tonsils are full and smooth ; 
there is no ulceration, sometimes an odor, as in measles, 
attends the rash. The eyes are suffused, but there is 
little or no coryza ; the lids are somewhat swollen and 
irritable ; the face is flushed and the cheeks are full and 
red before the appearance of the snots. These are 



DISEASES OF INFANCY AND CHILDHOOD. 



195 



onght red, raised, rounded, with clear skin between 
them, but they soon coalesce ; not grouped as in meas- 
les, the spots are more prominent than in scarlet fever, 
and there is not that finely diffused redness of the neck 
and chest observed in that disease. 

Moreover the rash is already fading from the face and 
upper part of the body while extending to the limbs, so 
that it is less intense on the third day." Quairfs Med, 
Dictionary. 

The most important thing connected with this disease, 
is to avoid the mistake of calling a mild case of scarlet 
fever a case of German Measles. 

The following table shows some dissimilar symptoms 
of these eruptive diseases. 



GERMAN MEASLES. 

Symptoms of invasion 
often absent. 



Generally a little sore 
throat. 



Sometimes, a 
cough. 



slight 



Temperature 99 to 100 
degrees. 

Eruption in slightly 
raised pimples, or of 
quite uniform redness. 

Eruption light in color 



Characteristic compli- 
cations or sequels, quite 
rare. 



SCARLETINA. 

Symptoms of inva- 
sion never absent, con- 
tinue about one day. 

Decided sore throat. 



No cough. 



Temperature high, 
103 to 105 degrees. 

Smooth scarlet rash. 



Eruption scarlet in 
color. 

Complications not 
uncommon, such as, 
acute Blight's disease, 
abscesses, sores in the 
ear, rheumatism, etc. 



MEASLES. 

Symptoms of inva- 
sion never absent, con- 
tinue 3 to 5 days. 

Sore throat, if any, 
slight. 

A hard dry cough, 
nearly always. 

Temperature 102 de- 
grees or more. 

Eruption in blotches, 
a little raised, making 
the skin rough to the 
feel. 

Eruption darker in 
color. 

Complications, such 
as bronchitis, pneumo- 
nia, intestinal inflam- 
mation, diarrhoea, quick 
consumption, not un- 
common. 



In the way of treatment but little, if any, medicine is 
needed. Keeping within doors for a few days and avoid- 



396 HANDBOOK. 

ing exposure to cold and dampness are proper hygienic 
measures. 

Chicken Pox (Varicella) is a contagious, eruptive 
disease of little importance, almost peculiar to infants 
and children. After a period of short incubation — four 
days — an eruption of transparent water blisters (vesi- 
cles), not numerous, begins generally on the breast and 
shoulders, sometimes on the scalp, rarely a few on the 
face ; each vesicle is surrounded by slight redness ; the 
affection runs its course in about six days. Fever and 
other constitutional symptoms, if any, are slight. The 
disease might possibly be mistaken for varioloid ; in the 
latter disease hard red pimples first appear, but in chick- 
en-pox the eruption is vesicular. It is stated by some 
writers that at the very first the eruption appears in the 
form of small red spots upon which the vesicles are de- 
veloped the second day. On the fourth day the vesicles 
begin to shoal and on the fifth or sixth they dry into a 
thin brownish scab. While this course is pursued by 
one crop of vesicles, others ajjpear, so that after a few 
days, the eruption may be seen in all its stages of de- 
velopment at the same time. Little difficulty will be 
found in recognizing a case of chicken-pox if it is recol- 
lected that the eruption is in the form of small water 
blisters, not very numerous, and with healthy skin inter- 
vening. The patient is only slightly sick, if sick at all. 
N"o other eruptive disease bears a close resemblance to it, 
and no treatment is required, save attention to the bowels. 



DISEASES OF INFANCY AND CHILDHOOD. 397 

DIPHTHERIA. 

Diphtheria, according to the belief of those who have 
carefully examined the evidences, is not a new disease. 
It is said that medical writers who lived in the first cen- 
tury give unmistakable accounts of a throat distemper 
which was, probably, the same thing as the disease now 
called diphtheria ; some writers say that Homer, and Hip- 
pocrates, the father of medicine, who lived in the fourth 
century, B. C, referred to the disease in their writings. 

It is a curious fact that the contagious and infectious 
diseases all came from the old world to the new. Small- 
pox was first brought to this country by European ad- 
venturers and communicated to the Incas, the ancient 
inhabitants of Peru, to the Aztecs of Mexico, and lo ! to 
the poor Indians. It had been the most terrible and 
destructive contagious disease in the world till it re- 
ceived almost its death blow by the practice of vaccina- 
tion, introduced by Dr. Edward Jenner of England, in 
the year 1796, to the immortal glory of medical science. 
Cholera has been somewhat checked by modern pro- 
phylactic and sanitary measures. The contagious erup- 
tive fevers are prevented from spreading in extensive 
epidemics by more scientific methods of limiting the 
contagion. 

Though diphtheria has been long known and studied 
by medical men, as yet no medicine has been discovered 
which approximates a certainty of effecting a cure. The 
long list of fatal cases casts a dark shadow across the 



398 HANDBOOK. 

pages of medical literature. It is supposed, or perhaps 
known, to be a germ disease, and germicides and anti- 
septics have been tried, but not with entirely satisfactory 
results. It is yet a mooted question whether the disease 
is really a constitutional one at first, having a local ex- 
pression in the form of an exudated membrane upon the 
throat or other parts, or whether it is at the first a pure- 
ly local affection, beginning with this membrane, from 
which in a short time systemic poisoning or infection 
results. Although diphtheria when it once seizes the 
patient, is not well controlled by medicine, it is now 
considered a preventable disease to a very great extent 
— it can, probably, be limited to the first case, or pre- 
vented from escaping- upon the community, and in this 
sense, is preventable. 

The contagion is propagated by the breath, by cloth- 
ing and furniture and in many other ways. Unless a 
room in which a diphtheretic patient has been sick is 
thoroughly disinfected, it is liable to communicate the 
infection to a child entering it weeks or months there- 
after. It is said that if the infectious germs of the dis- 
ease are once lodged in sewers, cellars and dark damp 
places, where the sun seldom enters, that they remain 
and develop, and vapors arising from such places are 
likely to convey the contagium to susceptible persons, 
thus explaining cases in which the attack apparently 
occurs without exposure. It is thought that domestic 
animals, especially the feathered tribes, sometimes take 
the disease and communicate it to persons. 



DISEASES OF INFANCY AND CHILDHOOD. 399 

Children between the ages of two and twelve years 
are the most susceptible to the contagion of diphtheria, 
but an attack is not extremely rare in adults. One 
writer states that in Vienna, out of five hundred deaths 
from diphtheria, but one had reached the age of sixty 
years. This proportionate number of adults is alto- 
gether too small, according to the experience of the 
writer in passing through several epidemics; for in- 
stance, in one of these outbreaks the writer, then forty 
years of age, and also his wife contracted the disease ; 
his mother, aged sixty-five years, and visiting the fam- 
ily, also caught the disease. 

Symptoms. The prodromal, or fore-running symp- 
toms of an attack of diphtheria may not be very distinc- 
tive — they may not markedly differ from those which 
usher in some other acute inflammatory diseases attend- 
ed with sore throat. The attack often seemingly begins 
abruptly, or it may be preceded for a few days by 
languor, a little loss of strength and depression of spirits. 
In a well marked, or typical case, there is at first a feel- 
ing of chilliness, followed by more or less fever, often 
nausea or vomiting (in children), headache, pain in the 
back and limbs, and other fever symptoms, and loss of 
appetite and strength. Sore throat, a little stiffness of 
the neck and swelling of the glands at the angle of the 
lower jaw are soon noticed. These symptoms are suf- 
ficient to raise a reasonable suspicion of diphtheria, 
provided they are well marked and no additional symp- 
toms are present, which plainly point to some other 



400 HANDBOOK. 

ailment as the cause of the sickness. To make sure, or 
to verify the suspicion, the throat must be carefully ex- 
amined. Take the patient to the window where there 
is good light, require him to open the mouth widely and 
speak the syllable ah, prolonging the sound, which 
brings the back part of the throat into good view, if not, 
the tongue must be depressed. If the case is one of 
diphtheria, and if the patient has been sick twenty-four 
hours, sometimes less, a diphtheretic patch or patches 
will probably be seen. At first a small slightly raised, 
whitish or grayish patch or pellicle is discovered in the 
depression of the reddened and swollen tonsil ; it looks 
very much as if a small piece of common putty had been 
stuck upon the tonsil. Take a firm swab and try to 
brush off the j)atch ; if it adheres firmly, or if when torn 
off a little blood appears, it means that the membrane is 
diphtheretic; the patch of membrane soon returns. 
The color of these patches changes with age ; after a 
few days they grow darker and ragged looking. The 
throat is much inflamed and reddened over a considera- 
ble area. If the masses are easily brushed off, and if 
they are cheesy and friable — not membranes — they are 
exudates resulting from simple inflammation of the 
throat, or from tonsillitis ; follicular tonsillitis is often 
mistaken for diphtheria, because of the whitish pellicles 
on the throat. In true diphtheria the characteristic 
false membrane is usually first discovered in the depres- 
sions of the swollen tonsils, but not always; it may 
spread to other parts of the throat as the soft palate and 



DISEASES OF INFANCY AND CHILDHOOD. 423 

water should be applied to the throat. Fifteen drops 
of the tincture of aconite should be added to half a 
tumblerful of water and a teaspoonful given every 20 
minutes till the skin is moistened with perspiration. 
The patient ought to be kept in a warm bed. If old 
enough to gargle the throat, a weak solution of the 
chlorate of potash should be used for the purpose. 
Pounded ice may be allowed for the child to swallow, if 
the throat is much inflamed. It is well to give at first 
some laxative medicine. 

Hoarseness due to Laryngitis. This affection is 
so common in childhood that it is worthy of mention. 
The larynx is that part of the wind-pipe in which the 
voice-forming apparatus is situated; if it is inflamed 
there is a change in the voice, or the voice may be en- 
tirely lost for a time. In its sinrple form, laryngitis is 
the result of a common cold, and is similar in its nature 
to a cold in the head (acute coryza,) or to bronchitis, 
which affections indeed often co-exist. Laryngitis is 
one of the principal causes of spasmodic and membran- 
ous croup. In simple laryngitis there is sometimes a 
dry harsh cough, but the breathing is usually natural, 
excepting a little hurried ; in other cases nothing calls 
the attention to the affection, other than the hoarseness 
when the child cries or speaks. Even if the voice is en- 
tirely lost, mothers should not be alarmed for there is 
little or no danger in such a case, excepting that symp- 
toms of croup appear. The child recovers from these 



424 HANDBOOK. 

attacks in a week or more. The treatment may be the 
same as that recommended above for sore throat, which 
see. 

Glandular Swellings of the Neck. It is not an 
uncommon thing for children, from some unhealthy con- 
dition of the system, to have one or more of the many 
glands about the neck greatly swollen. Physicians 
formerly were in the habit of calling all neck swellings 
and enlargements scrofulous, but it is only in exception- 
al cases that they are of this nature, because from ex- 
posure to cold and a sore throat such swellings are often 
noticed, disappearing in a few days. The writer has 
seen many cases in which these swellings came up with- 
out any well known cause, continued for several weeks, 
and then gradually disappeared ; but it occasionally hap- 
pens that they suppurate, that . is, an abscess forms and 
breaks, and when healing has taken place a scar is left. 
It is good treatment in cases of these glandular swell- 
ings, at first, if there is not great inflammation, to paint 
them over with the tincture of iodine once or twice a 
day. Should there be considerable heat and redness, 
with a strong tendency to an abscess, a poultice should 
be applied till it breaks or is opened. If the child seems 
unhealthy and the swelling slow and indolent, the Com- 
pound Syrup of the Hypophosphites is an excellent 
medicine, and should be given — dose, a teaspoonful 
three times a day to a child five years old, a little more 
to an older child. 



DISEASES OF INFANCY AND CHILDHOOD. 421 

their nature to the nightmares of adults, free from dan- 
ger to life. Th* 1 attack may possibly return for several 
nights in succession, if the cause is not removed. Con- 
stipation of the bowels, over eating, or other disorders 
of the stomach, irritation from teething, intestinal worms 
and other causes may produce the trouble. To prevent 
a return all the known causes must be removed and the 
little patient's health and habits improved. 

Sometimes a few doses of some laxative medicine is 
sufficient to a cure ; in other cases, in which the stomach 
is overloaded, an emetic is the thing needed, afterwards, 
care that easily digested food in proper quantity is 
given. 

A Rupture at the Navel is not infrequent in infants. 
It is known from the fact that when the child cries or 
coughs a little tumor is pressed out at the navel ; com- 
plete healing had not taken place after the navel string 
came off. Usually the trouble is easily cured in this 
way: take a good bandage and sew up in it a silver half 
dollar ; apply the bandage quite tightly around the body 
so that the silver piece will constantly press upon the 
rupture ; by wearing this several weeks the infant is en- 
tirely cured. 

Infants and young children are often ruptured in the 
groin. It is a fortunate thing that prompt treatment, 
as a rule, brings about a cure. A light, nicely fitting 
truss should be obtained, put on and worn till the her- 
nial tumor entirely disappears, and even for sometime 



422 HANDBOOK. 

thereafter, to prevent all danger of a return from a 
strain during violent efforts. 

Inflammation of the Throat and Tonsils. Weak 
and scrofulous children are very apt to contract a slight 
cold and a sore throat from exposure, and after repeated 
attacks the tonsils remain in a condition of chronic en- 
largement, giving to the voice a peculiar tone. The 
mucous membrane of the throat is over sensitive and a 
slight exposure induces a sore throat. During the first 
attacks there is considerable fever, a throbbing pain in 
the throat and difficulty in swallowing. If the throat is 
examined, it is seen to be reddened and the tonsils more 
or less swollen ; possibly there may be spots of a whitish 
color slightly resembling diphtheritic patches. The 
points of difference between these and true diphtheria 
patches are fully given under the subject diphtheria, 
which see. 

Beginning in this way in older children, an abscess 
may form in the tonsil and after a time break, or the af- 
fection may disappear without an abscess. If chronic 
enlargement of the tonsils results, the child is apt to be 
deaf for a time. 

In the treatment of the first attacks of this kind, if 
there is considerable fever and sore throat, two tea- 
spoonfuls of the syrup of ipecac should be given, or 
enough to produce vomiting. Probably no treatment at 
first is so effective in aborting this affection. Children 
vomit without much difficulty. Flannels dipped in hot 



DISEASES OF INFANCY AND CHILDHOOD. 419 

to one teaspoonful three times a day ; last dose at bed- 
time. Increase the dose according to age. 

Atropinae sulph, two grains, aquae dest. two ounces. 
Mix. Dose — Give one drop for each year of age of the 
patient at 4 and 7 o'clock each evening. 

Any good druggist will put up the above prescriptions. 
Avoid "sweets" and allow no fluids for a few hours 
before retiring ; take the child up once after midnight 
to empty the bladder. The remedies should be given 
for several weeks, and the dose cautiously increased, if 
needed to have the desired effect. For ordinary cases 
there are no better remedies than these. Possibly a 
tonic may be required. 

Falling of the Bowel, (Prolapse of the Anus.) 
This painful accident may occur as a consequence of 
protracted diarrhoea, severe constipation and straining, 
or from great debility. It is quite easily recognized. 
The child is observed to suffer greatly after an opera- 
tion of the bowels, and on examination a red tumor is 
discovered at the opening of the lower passage ; it con- 
sists of folds of the rectum, or lower bowel, which have 
passed down below the sphincter muscle, and are so 
grasped by it that the pain continues till the protruded 
folds are put back into place. Reduction may be thus 
performed : smear the part with vaseline, sweet oil or 
lard, then with a piece of soft cloth gently press the 
folds back into the bowel, making sure the entire part is 
pressed within the constricting muscle. This is more 



420 HANDBOOK. 

easily effected if the child lies belly down across th« 
operator's lap. 

If this cannot be done without producing too mucii 
pain, a cloth dipped in cold water or in hot water must 
be pressed upon the part till congestion is somewhat re- 
lieved, when another attempt must be made to reduce 
it. A pad may be needed to prevent the part from 
coming down again ; this can be kej)t in place by bind- 
ing it on by means of a strap, tied to one around the 
waist, or the child may be kept in bed for a few days. 

Great care must be taken to prevent constipation, by 
giving some gentle laxative, thus preventing straining 
operations. 

Night Terrors in Children. Dr. West, formerly 
the great English authority on the diseases of children, 
describes an attack as follows : "It happens sometimes 
that a child who has gone to bed apparently well and 
has slept soundly for a short time awakes suddenly in 
great terror and with a loud and piercing cry. The 
child will be found sitting up in its bed crying out as if 
in agony or fear, Oh dear! Oh dear! take it away! 
Father! Mother! while terror is depicted on its counte- 
nance and it does not recognize its parents, who alarmed 
by the shriek have come into the room, but seems wholly 
occupied with the fearful impression that has aroused it 
from sleep. By degrees consciousness returns." 

There is no occasion for alarm from these seizures to 
Which nervous children are subject ; they are similar in 



DISEASES OF INFANCY AND CHILDHOOD. 417 

the ends of the long bones, especially at the wrist and 
ankles, so that these joints appear larger than natural ; 
this sign confirms the suspicion of rickets, which other 
symptoms seem to point to, and the proper treatment 
should begin at once. An infant manifesting these 
symptoms should receive prompt attention with the 
reasonable expectation that a cure would be made. The 
writer from his own experience would recommend two 
remedies, which in his hands, have been remarkably 
effective, namely : cod liver oil and phosphorus, which 
may be given in combination. An emulsion of cod liver 
oil and the syrup of hypophosphites makes an excellent 
mixture. The syrup of the lacto-phosphate of lime to a 
feeble child with deficient development of the bone is a 
medicine highly valued — dose, a teaspoonful three times 
a day to a child two years old. If there are suspicions 
that rickets is threatening the medicine should by all 
means be given. 

Incontinence of Urine, (Bed Wetting) is not an 
uncommon habit of children from three to twelve or fif- 
teen years of age, and may continue till the child is much 
older. The causes are numerous, and could not be well 
understood except by a physician. Many physicians 
think the habit is brought on by allowing children to 
drink too much water or milk in the latter part of the 
day, or by exposure to cold in the night, or lying on the 
back in the night — a posture which is unfavorable to 
retention of urine if the neck of the bladder is irritable, 



418 HANDBOOK. 

as it is liable to be. In some cases the habit may be 
cured in its early stages without medicine, by great care 
of the child, by allowing but a small amount of drink in 
the afternoon, and by taking the child up in the night 
to empty the bladder, but, generally speaking, appropri- 
ate remedies are required to break up the habit, and in 
many instances the child's health must be improved be- 
fore a cure can be effected. 

The last case I treated was uncontrollable till the 
Elixir of Gentian and Iron, a tonic, was prescribed, after 
which the trouble ceased. In the majority of cases the 
trouble is due to constitutional weakness or to weakness 
of certain muscles, or to undue irritability. 

Dr. Johnston, of Washington, says : — 

"I have been using for many years the fluid extract 
of ergot in the treatment of incontinence of urine in in- 
fants and children ; and I almost regard it as a specific 
for the disease. I give to an infant from one to three 
years old, 5 to 10 drops ; and to a patient from three to 
ten years, 10 to 20 drops every three hours. Few chil- 
dren object to its taste, and it should be continued unin- 
terruptedly for two or three weeks, and resumed if the 
disease should return, in which case the doses ought to 
be gradually increased." 

Another high authority prescribes the following for a 
child three years of age : — 

Tincture belladonna, two drams, fluid extract of rhus 
aromatica, two ounces, glycerine, two ounces, water suf- 
ficient to make four ounces. Mix. Dose. — One-half 



MISCELLANEOUS SUBJECTS. 431 

and debility a wonderfully good effect, while in bilious- 
ness they would be injurious. 

Only light and easily digested foods, and in small 
quantities should be taken, avoiding all fatty foods. 

Kidney Complaints. Patent medicines are very 
extensively advertised (and sold too) as "sure and safe 
cures" for these complaints. The people have been 
educated to regard nearly every urinary disorder as a 
kidney complaint; but as a matter of fact, the majority 
of the affections which receive this name, do not arise 
from a real disease of the kidneys — more commonly 
from some irritation or slight inflammation of the blad- 
der; or from diseases of some adjacent organ, in oldish 
men from an enlargement of the prostate gland; or 
from some irritating, acid or ammoniacal condition of 
the urine. Again, some persons infer from a changed 
appearance of the water that they have a kidney disease 
— if the water deposits a brick dust sediment, or is very 
turbid and cloudy after cooling. Such unnatural ap- 
pearances may possibly indicate a real disease of the 
kidneys, but more frequently they do not. Indiges- 
tion, a bilious disease, certain kinds of food or drinks, 
or disorders of some other organs of the body produce 
the abnormal condition. 

Again, owing to an acid or irritating condition of the 
urine, a slight inflammation of the bladder, water pas- 
sages or some disease of the rectum, and many other 
things, such as nervousness, there is often a desire to 



432 HANDBOOK. 

pass water with unnatural frequency, sometimes attend- 
ed with pain ; the kidneys may be perfectly healthy. 

Some of the most common chronic diseases of the kid- 
neys are here briefly described, that persons proposing 
to take patent or other medicines for kidney disease, 
may have some basis for judging for themselves as to 
the nature of their complaints. 

Bright's Disease. Briefly stated, chronic inflamma- 
tion of the kidneys, which often results in chronic 
Bright's Disease, is variously produced — sudden or pro- 
longed exposure to cold, which checks the healthy 
action of the skin and throws extra eliminating work 
upon the kidneys, produces congestion, which is the 
first stage of inflammation. Continued over eating of 
rich foods, indigestion and mal-assimilation throw an 
abnormal amount of work upon the kidneys which can be 
but imperfectly done — waste and poisonous materials of 
the body are largely eliminated by the kidneys, in some 
cases producing such an amount of irritation, that true 
inflammation ensues. Persons of intemperate habits 
those who live in damp houses, and those poorly nour- 
ished, are more liable to the disease ; it follows the acute 
form in some instances. It would be a bootless task to 
describe here the early symptoms of this disease ; they 
are often insidious and uncertain ; an examination of the 
urine, from time to time, for the presence of albumen 
and casts, is the only trustworthy means of settling the 
question as to the existence of Bright's disease. 




Dr. Edward Jenner. 



The renowned doctor who introduced to the world the 
practice of Vaccination, the greatest achievement in pro- 
phylactic practice ever known. Dr. Jenner was born in 
Gloucestershire, Eng., in the year 1749. When convinced 
that vaccination would prevent small pox, he went up to 
London and made the discovery known. Physicians in the 
great metropolis, at first looked upon it with disfavor or in- 
credulity, but within a year it came into favor with them. 
Parliament even rewarded him with generous gifts of money 
and praise (£30,000). In 1858 a statue was erected to his 
honor, in London. 



MISCELLANEOUS SUBJECTS. 429 

much like those of biliousness and liver disease. The 
liver and the bile may be in a healthy condition, but the 
swelling of the bile-passages prevent its out- flow ; distur- 
bances of the stomach and jaundice are apt to be the 
prominent symptoms. The inflammation, which is the 
exciting cause of this trouble, extends up from the 
duodenum (the upper intestine into which the bile-duct 
opens) so that inflammation of the duodenum is the 
primary disease. This should be thought of as the pos- 
sible cause of symptoms like those of liver complaint. 

Treatment of Biliousness. If a person continues 
for a time in ill health, having more or less of the above 
named symptoms, and no other known disease is pres- 
ent to account for them, it may be inferred that he is 
bilious. There are two other ailments for which it may 
be mistaken, namely, indigestion and lithaemia. Com- 
ing to treatment, it may be said that for simple, yet 
often satisfactory treatment, the so called saline laxa- 
tives, such as Epsom salts, Seidlitz powders, Rochelle 
salts, and the laxative mineral waters, such as Vichy, 
Bethesda, Apollinaris, drank in considerable quantities, 
may be tried. From the writer's own experience, and 
from the united testimony of most patients as well as 
physicians, it must be said that, in cases of real bilious- 
ness no remedy has such a marked, immediate and won- 
derfully good effect as a pill made of blue mass, three 
grains, taken at night and followed in the morning, be- 
fore eating, by one or two Seidlitz powders or a drink 
of Epsom or Rochelle salts, sufficient to produce a free 



430 HANDBOOK. 

operation. Such treatment is perfectly harmless and 
perfectly good. If the patient is not cured the dose 
may be repeated the third night. 

Besides these remedies, the diluted Nitromuriatic 
Acid in about 10 drop doses, taken in sugared water 
three or four times a day, has usually an excellent and 
curative effect. 

The following mixture is a bitter dose, but in many 
cases it is extremely beneficial in biliousness from torpor 
of the liver: The Chloride of Ammonia, 3 drachms; 
Fluid Extract Dandelion Root, ^ ounce; Syrup of 
Ipecac, 1 ounce; Compound Decoction of Aloes, 2 
ounces; Compound Syrup of Stillingia, 2 ounces; water 
to make 8 ounces. Mix. Dose : a teaspoonf ul in sweet- 
ened water 3 or 4 times a day. 

To some persons pills are more agreeable, and may be 
taken for these bilious troubles. The standard Com- 
pound Cathartic pills which every druggist keeps, often 
effect a cure ; take two at night, and if needed, two the 
second night. Get from the druggist the Compound 
Rhubarb pill and take 2 or 3 every other night. 

The sarsaparilla mixtures, so often taken for bilious- 
ness, are in the opinion of the writer, very poorly 
adapted to such cases, and may be positively harmful. 
The patient may recover while taking the medicine, but 
he probably would do better without it. 

In a real case of biliousness, tonics are not well 
borne ; for instance, some preparations of iron, combined 
with the bitter tonics, have in many cases of anaemia 




Calf upon the Vaccinating Table (From Vaillard.) 

In order to obtain vaccine matter [lymph] pure and in its 
full degree of strength, healthy calves, six or eight weeks 
old, are vaccinated, as represented in the above cut. The 
hair is first clipped and then the skin lathered and shaved 
with a razor. When the vesicles are ripe, the lymph is 
pressed out and smeared upon ivory points, or put into capil- 
lary glass tubes for use. Formerly the crust, or scab, 
was much used, but it is objectionable, as containing impur- 
ities. What is called in the market, "bovine virus," is thus 
obtained. It "takes" with more violence, but is supposed 
to afford surer protection against small pox. Ivory points 
thus charged can be bought in all large cities ; they must be 
fresh to be effective. 



MISCELLANEOUS SUBJECTS. 427 



Miscellaneous Subjects. 



LIVER COMPLAINT AND BILIOUSNESS. 

Perhaps no remark regarding the health is more 
frequently heard than this : " I am bilious, or I have 
the liver complaint. What are these affections and 
what are the syu^toms which point to their real exis- 
tence? A class of cases called bilious, manifest more or 
less of these phenomena: a poor appetite, a coated 
tongue, a bitter taste in the mouth, nausea and some- 
times vomiting, usually constipation of the bowels, but 
possibly bilious diarrhoea, headache, giddiness, a feeling 
of languor and disinclination to physical or mental 
effort, and often great depression of spirits ; and some- 
times a dull and sleepy feeling, a sallow complexion, a 
yellow tinge of the whites of the eyes, a slow pulse very 
characteristic. The discharges from the bowels are often 
"clay colored," being deficient in the coloring matter 
of the bile ; the urine darker colored than natural, con- 
taining as it does, an abnormal amount of the bilious 
coloring matter. 

Many physicians believe that such cases are mostly 
due to a catarrhal inflammation of the stomach or 
duodenum (the upper intestine). It will be noticed 



428 HANDBOOK. 

that some of the symptoms are the same as those which 
are present in chronic indigestion or dyspepsia; yet 
when the stools are light colored and the white of the 
eyes and skin slightly jaundiced, it would certainly ap- 
pear that the bile does not follow its normal course; 
again, the biliousness disappears after the use of certain 
remedies that do not have so favorable an effect in pure 
and simple disorders of the stomach and duodenum. 

The liver is the largest gland in the body, and plays 
an important role in the economy of the system, and it 
would seem entirely probable that it does sometimes be- 
come disordered in its action and leads to various 
disturbances. A little mistrust rests upon the term 
" liver complaint," for it is a kind of a scape-goat, that is, 
when a person is suffering from an obscure ailment, 
liver complaint is a convenient name for a physician to 
apply to it. It is probably true however, that the liver 
gets torpid or congested to a certain extent, and requires 
treatment. 

In a well marked case of congestion or torpor of the 
liver, there is likely to be a sensation of weight and dis- 
comfort in the right side, and an aching feeling through 
the right shoulder. As the liver secretes the bile which 
is poured into the upper intestine, and takes a certain 
part in the intestinal digestion of food, it may be under- 
stood how it happens that in case the liver is torpid, di- 
gestion is imperfect. 

There is another affection, namely, a catarrhal inflam- 
mation of the gall-ducts, which manifests symptoms 



DISEASES OF INFANCY AND CHILDHOOD. 425 

Sore Eyes in Children- From different, and some- 
times unknown causes, children suffer from weakness 
and soreness of the eyes ; the lids stick together in the 
morning. There may be considerable redness of the 
eyes and lids ; a bright light seems to be hurtful and 
painful. Dirt which might have gotten into the eyes, 
or hairs from the eyelashes which have| become turned 
inward upon the eyeball to irritate and inflame it, 
should be thought of as the possible cause of continued 
painful and sore eyes. In some cases there is more or 
less smarting and burning feelings, and the child is in- 
clined to rub the eyes. 

As regards treatment, it may be said that the applica- 
tion of cold water, in which a little powdered borax has 
been dissolved, is one of the very best remedies. A 
soft cloth can be wet in the solution and held upon the 
eyes by a bandage, allowing some of the water to get 
into the eye. If borax is not at hand, salt and water 
may be used in the same way ; the amount that can be 
taken up on the end of a pocket-knife added to a cup of 
cold water. An excellent eye wash is made by add- 
ing to four ounces of rose-water, four grains of the 
sulphate of zinc (white vitriol.) See in another part of 
this book the treatment of sore and inflamed eyes. 

A Stye is a minute boil which appears on the edge of 
the eyelids ; it may be quite painful to the child and ex- 
cite much swelling of the lid, so that the eye is closed. 
Excepting the pain and discomfort which they produce 



426 HANDBOOK. 

they are rather innocent things and soon disappear. 
They should not be squeezed or troubled by attempting 
to open. If hot and painful, a cloth dipped in hot 
water may be applied to relieve the pain and inflamma- 
tion. 

Discharges from the Ears. Feeble and unhealthy 
children are subject to a running from the ears, which if 
not properly treated, continues along time and has an of- 
fensive odor. Such discharge is sometimes thin, in other 
cases thick and mattery. There are more or less uneasy 
sensations in the ear and often earache. Such a trouble 
often arises from an inflammation of the ear-canal, and 
does not tend to produce deafness, and is not a real ab- 
scess in the ear. The trouble may be greatly benefitted 
by pouring into the ear, while the child lies on his side 
a solution of powdered borax and warmish water, one 
half teaspoonful to a cup of water ; after remaining two 
or three minutes turn it out and repeat several times a 
day. A weak solution of alum and water is also a very 
good remedy, used in the same way. 

Earache in children is fully treated on page 196. 

Toothache in children is fully treated on page 193. 

Humors or Skin Diseases — Ailments rathe*r more 
common in children than in adults — are fully treated of 
in this book, beginning on page 307. 



DISEASES OP INFANCY AND CHILDHOOD. 417 

the ends of the long bones, especially at the wrist and 
ankles, so that these joints appear larger than natural ; 
this sign confirms the suspicion of rickets, which other 
symptoms seem to point to, and the proper treatment 
should begin at once. An infant manifesting these 
symptoms should receive prompt attention with the 
reasonable expectation that a cure would be made. The 
writer from his own experience would recommend two 
remedies, which in his hands, have been remarkably 
effective, namely : cod liver oil and phosphorus, which 
may be given in combination. An emulsion of cod liver 
oil and the syrup of hypophosphites makes an excellent 
mixture. The syrup of the lacto-phosphate of lime to a 
feeble child with deficient development of the bone is a 
medicine highly valued — dose, a teaspoonful three times 
a day to a child two years old. If there are suspicions 
that rickets is threatening the medicine should by all 
means be given. 

Incontinence of Urine, (Bed Wetting) is not an 
uncommon habit of children from three to twelve or fif- 
teen years of age, and may continue till the child is much 
older. The causes are numerous, and could not be well 
understood except by a physician. Many physicians 
think the habit is brought on by allowing children to 
drink too much water or milk in the latter part of the 
day, or by exposure to cold in the night, or lying on the 
back in the night — a posture which is unfavorable to 
retention of urine if the neck of the bladder is irritable, 



418 HANDBOOK. 

as it is liable to be. In some cases the habit may be 
cured in its early stages without medicine, by great care 
of the child, by allowing but a small amount of drink in 
the afternoon, and by taking the child up in the night 
to empty the bladder, but, generally speaking, appropri- 
ate remedies are required to break up the habit, and in 
many instances the child's health must be improved be- 
fore a cure can be effected. 

The last case I treated was uncontrollable till the 
Elixir of Gentian and Iron, a tonic, was prescribed, after 
which the trouble ceased. In the majority of cases the 
trouble is due to constitutional weakness or to weakness 
of certain muscles, or to undue irritability. 

Dr. Johnston, of Washington, says : — 

"I have been using for many years the fluid extract 
of ergot in the treatment of incontinence of urine in in- 
fants and children ; and I almost regard it as a specific 
for the disease. I give to an infant from one to three 
years old, 5 to 10 drops ; and to a patient from three to 
ten years, 10 to 20 drops every three hours. Few chil- 
dren object to its taste, and it should be continued unin- 
terruptedly for two or three weeks, and resumed if the 
disease should return, in which case the doses ought to 
be gradually increased." 

Another high authority prescribes the following for a 
child three years of age : — 

Tincture belladonna, two drams, fluid extract of rhus 
aromatica, two ounces, glycerine, two ounces, water suf- 
ficient to make four ounces. Mix. Dose. — One-half 



DISEASES OP INFANCY AND CHILDHOOD. 419 

to one teaspoonful three times a day ; last dose at bed- 
time. Increase the dose according to age. 

Atropinae sulph, two grains, aquae dest. two ounces. 
Mix. Dose — Give one drop for each year of age of the 
patient at 4 and 7 o'clock each evening. 

Any good druggist will put up the above prescriptions. 
Avoid " sweets " and allow no fluids for a few hours 
before retiring ; take the child up once after midnight 
to empty the bladder. The remedies should be given 
for several weeks, and the dose cautiously increased, if 
needed to have the desired effect. For ordinary cases 
there are no better remedies than these. Possibly a 
tonic may be required. 

Falling of the Bowel, (Prolapse of the Anus.) 
This painful accident may occur as a consequence of 
protracted diarrhoea, severe constipation and straining, 
or from great debility. It is quite easily recognized. 
The child is observed to suffer greatly after an opera- 
tion of the bowels, and on examination a red tumor is 
discovered at the opening of the lower passage; it con- 
sists of folds of the rectum, or lower bowel, which have 
passed down below the sphincter muscle, and are so 
grasped by it that the pain continues till the protruded 
folds are put back into place. Reduction may be thus 
performed : smear the part with vaseline, sweet oil or 
lard, then with a piece of soft cloth gently press the 
folds back into the bowel, making sure the entire part is 
pressed within the constricting muscle. This is more 



420 HANDBOOK. 

easily effected if the child lies belly down across ths 
operator's lap. 

If this cannot be done without producing too mucii 
pain, a cloth dipped in cold water or in hot water must 
be pressed upon the part till congestion is somewhat re- 
lieved, when another attempt must be made to reduce 
it. A pad may be needed to prevent the part from 
coming down again ; this can be kept in place by bind- 
ing it on by means of a strap, tied to one around the 
waist, or the child may be kept in bed for a few days. 

Great care must be taken to prevent constipation, by 
giving some gentle laxative, thus preventing straining 
operations. 

Night Terrors in Children. Dr. West, formerly 
the great English authority on the diseases of children, 
describes an attack as follows : "It happens sometimes 
that a child who has gone to bed apparently well and 
has slejJt soundly for a short time awakes suddenly in 
great terror and with a loud and piercing cry. The 
child will be found sitting up in its bed crying out as if 
in agony or fear, Oh dear! Oh dear! take it away! 
Father! Mother! while terror is depicted on its counte- 
nance and it does not recognize its parents, who alarmed 
by the shriek have come into the room, but seems wholly 
occupied with the fearful impression that has aroused it 
from sleep. By degrees consciousness returns." 

There is no occasion for alarm from these seizures to 
Which nervous children are subject ; they are similar in 



DISEASES OP INFANCY AND CHILDHOOD. 421 

their nature to the nightmares of adults, free from dan- 
ger to life. The attack may possibly return for several 
nights in succession, if the cause is not removed. Con- 
stipation of the bowels, over eating, or other disorders 
of the stomach, irritation from teething, intestinal worms 
and other causes may produce the trouble. To prevent 
a return all the known causes must be removed and the 
little patient's health and habits improved. 

Sometimes a few doses of some laxative medicine is 
sufficient to a cure ; in other cases, in which the stomach 
;is overloaded, an emetic is the thing needed, afterwards, 
care that easily digested food in proper quantity is 
given. 

A Rupture at the Navel is not infrequent in infants. 
It is known from the fact that when the child cries or 
coughs a little tumor is pressed out at the navel ; com- 
plete healing had not taken place after the navel string 
came off. Usually the trouble is easily cured in this 
way: take a good bandage and sew up in it a silver half 
dollar ; apply the bandage quite tightly around the body 
so that the silver piece will constantly press upon the 
rupture ; by wearing this several weeks the infant is en- 
tirely cured. 

Infants and young children are often ruptured in the 
groin. It is a fortunate thing that prompt treatment, 
as a rule, brings about a cure. A light, nicely fitting 
truss should be obtained, put on and worn till the her- 
nial tumor entirely disappears, and even for sometime 



422 HANDBOOK. 

thereafter, to prevent all danger of a return from a 
strain during violent efforts. 

Inflammation of the Throat and Tonsils. Weak 
and scrofulous children are very apt to contract a slight 
cold and a sore throat from exposure, and after repeated 
attacks the tonsils remain in a condition of chronic en- 
largement, giving to the voice a peculiar tone. The 
mucous membrane of the throat is over sensitive and a 
slight exposure induces a sore throat. During the first 
attacks there is considerable fever, a throbbing pain in 
the throat and difficulty in swallowing. If the throat is 
examined, it is seen to be reddened and the tonsils more 
or less swollen ; possibly there may be spots of a whitish 
color slightly resembling diphtheritic patches. The 
points of difference between these and true diphtheria 
patches are fully given under the subject diphtheria, 
which see. 

Beginning in this way in older children, an abscess 
may form in the tonsil and after a time break, or the af- 
fection may disappear without an abscess. If chronic 
enlargement of the tonsils results, the child is apt to be 
deaf for a time. 

In the treatment of the first attacks of this kind, if 
there is considerable fever and sore throat, two tea- 
spoonfuls of the syrup of ipecac should be given, or 
enough to produce vomiting. Probably no treatment at 
first is so effective in aborting this affection. Children 
vomit without much difficulty. Flannels dipped in hot 



DISEASES OF INFANCY AND CHILDHOOD. 4^3 

water should be applied to the throat. Fifteen drops 
of the tincture of aconite should be added to half a 
tumblerful of water and a teaspoonful given every 20 
minutes till the skin is moistened with perspiration. 
The patient ought to be kept in a warm bed. If old 
enough to gargle the throat, a weak solution of the 
chlorate of potash should be used for the purpose. 
Pounded ice may be allowed for the child to swallow, if 
the throat is much inflamed. It is well to give at first 
some laxative medicine. 

Hoarseness due to Laryngitis. This affection is 
so common in childhood that it is worthy of mention. 
The larynx is that part of the wind-pipe in which the 
voice-forming apparatus is situated; if it is inflamed 
there is a change in the voice, or the voice may be en- 
tirely lost for a time. In its simple form, laryngitis is 
the result of a common cold, and is similar in its nature 
to a cold in the head (acute coryza,) or to bronchitis, 
which affections indeed often co-exist. Laryngitis is 
one of the principal causes of spasmodic and membran- 
ous croup. In simple laryngitis there is sometimes a 
dry harsh cough, but the breathing is usually natural, 
excepting a little hurried ; in other cases nothing calls 
the attention to the affection, other than the hoarseness 
when the child cries or speaks. Even if the voice is en- 
tirely lost, mothers should not be alarmed for there is 
little or no danger in such a case, excepting that symp- 
toms of croup appear. The child recovers from these 



424 HANDBOOK. 

attacks in a week or more. The treatment may be the 
same as that recommended above for sore throat, which 
see. 

Glandular Swellings of the Neck. It is not an 
uncommon thing for children, from some unhealthy con- 
dition of the system, to have one or more of the many 
glands about the neck greatly swollen. Physicians 
formerly were in the habit of calling all neck swellings 
and enlargements scrofulous, but it is only in exception- 
al cases that they are of this nature, because from ex- 
posure to cold and a sore throat such swellings are often 
noticed, disappearing in a few days. The writer has 
seen many cases in which these swellings came up with- 
out any well known cause, continued for several weeks, 
and then gradually disappeared ; but it occasionally hap- 
pens that they suppurate, that is, an abscess forms and 
breaks, and when healing has taken place a scar is left. 
It is good treatment in cases of these glandular swell- 
ings, at first, if there is not great inflammation, to paint 
them over with the tincture of iodine once or twice a 
day. Should there be considerable heat and redness, 
with a strong tendency to an abscess, a poultice should 
be applied till it breaks or is opened. If the child seems 
unhealthy and the swelling slow and indolent, the Com- 
pound Syrup of the Hypophosphites is an excellent 
medicine, and should be given — dose, a teaspoonful 
three times a day to a child five years old, a little more 
to an older child. 



DISEASES OF INFANCY AND CHILDHOOD. 425 

Sore Eyes in Children- From different, and some- 
times unknown causes, children suffer from weakness 
and soreness of the eyes ; the lids stick together in the 
morning. There may be considerable redness of the 
eyes and lids ; a bright light seems to be hurtful and 
painful. Dirt which might have gotten into the eyes, 
or hairs from the eyelashes which have| become turned 
inward upon the eyeball to irritate and inflame it, 
should be thought of as the possible cause of continued 
painful and sore eyes. In some cases there is more or 
less smarting and burning feelings, and the child is in- 
clined to rub the eyes. 

As regards treatment, it may be said that the applica- 
tion of cold water, in which a little powdered borax has 
been dissolved, is one of the very best remedies. A 
soft cloth can be wet in the solution and held upon the 
eyes by a bandage, allowing some of the water to get 
into the eye. If borax is not at hand, salt and water 
may be used in the same way ; the amount that can be 
taken up on the end of a j)ocket-knife added to a cup of 
cold water. An excellent eye wash is made by add- 
ing to four ounces of rose-water, four grains of the 
sulphate of zinc (white vitriol.) See in another part of 
this book the treatment of sore and inflamed eyes. 

A Stye is a minute boil which appears on the edge of 
the eyelids ; it may be quite painful to the child and ex- 
cite much swelling of the lid, so that the eye is closed. 
Excepting the pain and discomfort which they produce 



426 HANDBOOK. 

they are rather innocent things and soon disappear. 
They should not be squeezed or troubled by attempting 
to open. If hot and painful, a cloth dipped in hot 
water may be applied to relieve the pain and inflamma- 
tion. 

Discharges from the Ears. Feeble and unhealthy 
children are subject to a running from the ears, which if 
not properly treated, continues along time and has an of- 
fensive odor. Such discharge is sometimes thin, in. other 
cases thick and mattery. There are more or less uneasy 
sensations in the ear and often earache. Such a trouble 
often arises from an inflammation of the ear-canal, and 
does not tend to produce deafness, and is not a real ab- 
scess in the ear. The trouble may be greatly benefitted 
by pouring into the ear, while the child lies on his side 
a solution of powdered borax and warmish water, one 
half teaspoonf ul to a cup of water ; after remaining two 
or three minutes turn it out and repeat several times a 
day. A weak solution of alum and water is also a very 
good remedy, used in the same way. 

Earache in children is fully treated on page 196. 

Toothache in children is fully treated on page 193. 

Humors or Skin Diseases — Ailments rather more 
common in children than in adults — are fully treated of 
in this book, beginning on page 307. 



MISCELLANEOUS SUBJECTS. 427 



Miscellaneous Subjects. 



LIVER COMPLAINT AND BILIOUSNESS. 

Perhaps no remark regarding the health is more 
frequently heard than this : " I am bilious, or I have 
the liver complaint. What are these affections and 
what are the symptoms which point to their real exis- 
tence? A class of cases called bilious, manifest more or 
less of these phenomena: a poor appetite, a coated 
tongue, a bitter taste in the mouth, nausea and some- 
times vomiting, usually constipation of the bowels, but 
possibly bilious diarrhoea, headache, giddiness, a feeling 
of languor and disinclination to physical or mental 
effort, and often great depression of spirits ; and some- 
times a dull and sleepy feeling, a sallow complexion, a 
yellow tinge of the whites of the eyes, a slow pulse very 
characteristic. The discharges from the bowels are often 
"clay colored," being deficient in the coloring matter 
of the bile ; the urine darker colored than natural, con- 
taining as it does, an abnormal amount of the bilious 
coloring matter. 

Many physicians believe that such cases are mostly 
due to a catarrhal inflammation of the stomach or 
duodenum (the upper intestine). It will be noticed 



428 HANDBOOK. 

that some of the symptoms are the same as those which 
are present in chronic indigestion or dyspepsia; yet 
when the stools are light colored and the white of the 
eyes and skin slightly jaundiced, it would certainly ap- 
pear that the bile does not follow its normal course; 
again, the biliousness disapj^ears after the use of certain 
remedies that do not have so favorable an effect in pure 
and simple disorders of the stomach and duodenum. 

The liver is the largest gland in the body, and plays 
an important role in the economy of the system, and it 
would seem entirely probable that it does sometimes be- 
come -disordered in its action and leads to various 
disturbances. A little mistrust rests upon the term 
" liver complaint," for it is a kind of a scape-goat, that is, 
when a person is suffering from an obscure ailment, 
liver complaint is a convenient name for a physician to 
apply to it. It is probably true however, that the liver 
gets torpid or congested to a certain extent, and requires 
treatment. 

In a well marked case of congestion or torpor of the 
liver, there is likely to be a sensation of weight and dis- 
comfort in the right side, and an aching feeling through 
the right shoulder. As the liver secretes the bile which 
is poured into the upper intestine, and takes a certain 
part in the intestinal digestion of food, it may be under- 
stood how it happens that in case the liver is torpid, di- 
gestion is imperfect. 

There is another affection, namely, a catarrhal inflam- 
mation of the gall-ducts, which manifests symptoms 



MISCELLANEOUS SUBJECTS. 429 

much like those of biliousness and liver disease. The 
liver and the bile may be in a healthy condition, but the 
swelling of the bile-passages prevent its out- flow ; distur- 
bances of the stomach and jaundice are apt to be the 
prominent symptoms. The inflammation, which is the 
exciting cause of this trouble, extends up from the 
duodenum (the upper intestine into which the bile-duct 
opens) so that inflammation of the duodenum is the 
primary disease. This should be thought of as the pos- 
sible cause of symptoms like those of liver complaint. 

Treatment of Biliousness. If a person continues 
for a time in ill health, having more or less of the above 
named symptoms, and no other known disease is pres- 
ent to account for them, it may be inferred that he is 
bilious. There are two other ailments for which it may 
be mistaken, namely, indigestion and lithaemia. Com- 
ing to treatment, it may be said that for simple, yet 
often satisfactory treatment, the so called saline laxa- 
tives, such as Epsom salts, Seidlitz powders, Rochelle 
salts, and the laxative mineral waters, such as Yichy, 
Bethesda, Apollinaris, drank in considerable quantities, 
may be tried. From the writer's own experience, and 
from the united testimony of most patients as well as 
physicians, it must be said that, in cases of real bilious- 
ness no remedy has such a marked, immediate and won- 
derfully good effect as a pill made of blue mass, three 
grains, taken at night and followed in the morning, be- 
fore eating, by one or two Seidlitz powders or a drink 
of Epsom or Rochelle salts, sufficient to produce a free 



430 HANDBOOK. 

operation. Such treatment is perfectly harmless and 
perfectly good. If the patient is not cured the dose 
may be repeated the third night. 

Besides these remedies, the diluted Nitromuriatic 
Acid in about 10 drop doses, taken in sugared water 
three or four times a day, has usually an excellent and 
curative effect. 

The following mixture is a bitter dose, but in many 
cases it is extremely beneficial in biliousness from torpor 
of the liver: The Chloride of Ammonia, 3 drachms; 
Fluid Extract Dandelion Root, ^ ounce; Syrup of 
Ipecac, 1 ounce; Compound Decoction of Aloes, 2 
ounces ; Compound Syrup of Stillingia, 2 ounces ; water 
to make 8 ounces. Mix. Dose : a teaspoonful in sweet- 
ened water 3 or 4 times a day. 

To some persons pills are more agreeable, and may be 
taken for these bilious troubles. The standard Com- 
pound Cathartic pills which every druggist keeps, often 
effect a cure ; take two at night, and if needed, two the 
second night. Get from the druggist the Compound 
Rhubarb pill and take 2 or 3 every other night. 

The sarsaparilla mixtures, so often taken for bilious- 
ness, are in the opinion of the writer, very poorly 
adapted to such cases, and may be positively harmful. 
The patient may recover while taking the medicine, but 
he probably would do better without it. 

In a real case of biliousness, tonics are not well 
borne ; for instance, some preparations of iron, combined 
with the bitter tonics, have in many cases of anaemia 



MISCELLANEOUS SUBJECTS. 431 

and debility a wonderfully good effect, while in bilious- 
ness they would be injurious. 

Only light and easily digested foods, and in small 
quantities should be taken, avoiding all fatty foods. 

Kidney Complaints. Patent medicines are very 
extensively advertised (and sold too) as "sure and safe 
cures" for these complaints. The people have been 
educated to regard nearly every urinary disorder as a 
kidney complaint; but as a matter of fact, the majority 
of the affections which receive this name, do not arise 
from a real disease of the kidneys — more commonly 
from some irritation or slight inflammation of the blad- 
der; or from diseases of some adjacent organ, in oldish 
men from an enlargement of the prostate gland; or 
from some irritating, acid or ammoniacal condition of 
the urine. Again, some persons infer from a changed 
appearance of the water that they have a kidney disease 
— if the water deposits a brick dust sediment, or is very 
turbid and cloudy after cooling. Such unnatural ap- 
pearances may possibly indicate a real disease of the 
kidneys, but more frequently they do not. Indiges- 
tion, a bilious disease, certain kinds of food or drinks, 
or disorders of some other organs of the body produce 
the abnormal condition. 

Again, owing to an acid or irritating condition of the 
urine, a slight inflammation of the bladder, water pas- 
sages or some disease of the rectum, and many other 
things, such as nervousness, there is often a desire to 



432 



HANDBOOK. 



pass water with unnatural frequency, sometimes attend- 
ed with pain; the kidneys may be perfectly healthy. 

Some of the most common chronic diseases of the kid- 
neys are here briefly described, that persons proposing 
to take patent or other medicines for kidney disease, 
may have some basis for judging for themselves as to 
the nature of their conrplaints. 

Bright's Disease. Briefly stated, chronic inflamma- 
tion of the kidneys, which often results in chronic 
Bright's Disease, is variously produced — sudden or pro- 
longed exposure to cold, which checks the healthy 
action of the skin and throws extra eliminating work 
upon the kidneys, produces congestion, which is the 
first stage of inflammation. Continued over eating of 
rich foods, indigestion and mal- assimilation throw an 
abnormal amount of work upon the kidneys which can be 
but imperfectly done — waste and poisonous materials of 
the body are largely eliminated by the kidneys, in some 
cases producing such an amount of irritation, that true 
inflammation ensues. Persons of intemperate habits ? 
those who live in damp houses, and those poorly nour- 
ished, are more liable to the disease ; it follows the acute 
form in some instances. It would be a bootless task to 
describe here the early symptoms of this disease ; they 
are often insidious and uncertain ; an examination of the 
urine, from time to time, for the presence of albumen 
and casts, is the only trustworthy means of settling the 
question as to the existence of Bright's disease. 



MISCELLANEOUS SUBJECTS. 433 

Regarding treatment, it may be said that it would be 
foolish in the extreme to expect benefit from any of the 
many "safe kidney cures" advertised ; drugs, known as 
yet, have little, if any, specific effect in curing the dis- 
ease ; they are often harmful. A good plan is, to drink 
freely every day of pure spring water (Poland Springs), 
to avoid stimulating foods and drinks, to take skimmed 
milk as a food and medicine, and to keep the skin in a 
healthy and active condition. 

Diabetes. The passage of an unnaturally large quan- 
tity of light colored urine, and great thirst are the 
conspicuous symptoms of Diabetes. Two forms are rec- 
ognized : first, sugar diabetes , second, diabetes insipidus, 
or polyuria. The two varieties differ considerably in 
their nature and gravity; the former is a chronic pro- 
gressive affection, not well controlled by medicine and 
often, but not always fatal ; the latter, diabetes insipidus, 
characterized by an excessive flow of water which does 
not contain sugar, is an ailment not so dangerous to life. 

There has been much dispute regarding the real cause 
of sugar diabetes. At present the most popular theory 
is, that some faulty action of the liver is the principle 
factor or operating cause — that the kidneys are at first 
not diseased, but simply eliminate the sugar contained 
in the blood. 

The patient's attention is first called to the fact that 
he is obliged to pass water much more frequently than 
usual, and that the amount is large, clear and pale, and 
that he is thirsty. If a little urine is placed in a shallow 



434 HANDBOOK. 

dish the watery part evaporates, leaving a sticky sedi- 
ment which contains sugar. 

The other variety, diabetes insipidus, as stated above, 
manifests symptoms at first very much like those of true 
diabetes, excepting that no sugar (in rare cases a little), is 
contained in the urine. The cause of this latter ailment 
is obscure. It follows in some cases disease or injury 
of the nervous system, for instance, sunstroke, a blow or 
fall upon the head, or exposure to the sun's rays. In- 
temperance seems to be the only assignable cause in 
some instances. 

The duration of diabetes insipidus is very uncertain ; 
in some cases several years, in some it terminates fatally. 
The affection is rather unmanageable, that is, not easily 
cured or well controlled by medicines. 

There is another important disease of the kidneys, 
not very uncommon, namely: a Calculous disease, in 
which concretions collect in the kidneys from urinary 
sediments ; these are called calculi, stones or gravel, if of 
small size. The presence of these foreign substances in 
the kidneys incites more or less inflammation and some- 
times an aching pain in the back until they pass out. 

There is often a severe aching pain in the back when 
a stone of some size moves about in the kidney, but the 
most severe paroxysms of pain are caused by the pas- 
sages of a rough stone of considerable size down 
through a small tube (the ureter) leading to the blad- 
der; these attacks of pain get the name nephritic, or 
kidney colic. Besides, the presence of these concretions 



MISCELLANEOUS SUBJECTS. 435 

often produces (sometimes it does not) an inflammation 
of the lining membranes of the kidneys: there is an 
aching pain in the back, chilly sensations, more or less 
fever, the urine is passed too often, and on cooling 
throws down a large amount of sediment composed of 
mucus or pus, possibly containing blood. The affection 
may run a protracted course and one of the kidneys be 
destroyed; more commonly convalescence takes place 
after a time. 

Such, briefly described, are the principle organic kid- 
ney diseases. But as referred to above, simple urinary 
functional disorders are vastly more common. Of all 
such affections, nothing is more common than chronic 
inflammation, or irritation of the bladder, as it compli- 
cates many other diseases and often exists independent- 
ly. Such a trouble is often called "irritable bladder." 
The causes are very numerous, some of which have 
been referred to above. The subject is too extensive to 
allow of a full discussion here. It may be said that it 
requires considerable scientific knowledge and experience 
in the diagnoses and treatment of this class of diseases, 
to be able to select at once the proper remedy. The 
less patent medicine taken the better. 

For a simple, yet often effective medicine in nearly all 
cases in which there is an irritation or an inflammation 
of the urinary organs, buchu leaves, barberry leaves, 
couch grass root, etc., steeped in water and freely drank, 
are often prescribed by physicians. If the urine is acid, 
the effect is better if a little bi-carbonate of soda is add- 



436 HANDBOOK. 

ed. Copious drinks of this kind render the urine bland 
and less irritating, and allay inflammation. 

In oldish people with a scanty flow of water, sweet 
spirits of nitre, one half teaspoonful several times a day, 
is very beneficial. 

An excellent remedy is the following mixture : Car- 
bonate of lithium, one-half ounce, fluid extract henbane, 
one ounce, fluid extract couch grass root, one ounce, 
compound tincture of cardamon, two ounces, simple syrup, 
one and one-half ounce. Mix, and take a teaspoonful in 
a little water, three or four times a day. 

If there is very much irritability, take 60 grains of 
bi-carbonate of soda and 40 grains of Dover's powders, 
mix and divide into twenty powders, and take one pow- 
der four times a day. 

There are acute ailments of this kind in which the 
symptoms are nearly the same, but very urgent and dis- 
tressing. For such attacks a Sitz-bath of water as hot 
as can be well borne works remarkably well. This may 
be followed by cold packs over the region of the kid- 
neys. 

Heart Complaints. Disturbances in the healthy 
and normal action of the heart, and sensations, either of 
pain or discomfort in the region of the heart, are so com- 
mon and so often lead to anxiety regarding the health, 
and a painful suspicion in the mind of the patient that 
organic disease of the heart is imminent, that the subject 
is interesting. 



MISCELLANEOUS SUBJECTS. 437 

In the first place, it may be said that organic heart 
diseases are mostly owing to the wear and tear and 
the degenerative changes incident to advanced age, 
so that the young and the middle aged are, broadly 
speaking, exempt, though the disease may be congenital, 
and is often a sequence of rheumatism. In the middle 
aged, functional diseases of the heart are very common, 
and arise from a great many and varied causes. 

By the term "functional disease" is meant a disorder 
in the office of an organ — not a structural organic 
change. But it should be understood that if the heart 
is diseased in structure, it will also manifest symptoms 
of functional disease, that is, as a rule. The causes of 
functional ailments, barring unusual cases, is summar- 
ized thus : 

(1). A changed or unhealthy condition of the blood 
as to quality or quantity. (2). Nervous influences, or 
faulty innervation. (3). Irritation reflected from othey 
diseased organs (sympathetic). 

1. The healthy action of the heart is dependent up- 
on its blood supply. If the patient is anaemic, that is, if 
the blood is poor in quality, being deficient in some of 
its normal elements, the action of the heart may be 
weak and irregular, as shown by a feeble and irregular 
pulse, and other well marked symptoms. Women are 
much more commonly subject to disordered action of 
the heart from this cause. Considerable hemorrhage or 
loss of blood from any cause, is apt to be followed by 
weakness or palpitation of the heart. On the other 



438 HANDBOOK. 

hand the plethoric, in whom the blood is rich in fibrin 
and reb blood-globules, suffer from over stimulation of 
the heart, and consequent palpitation. In brief, it may 
be said that there are a great many causes acting through 
the blood, which produce abnormal action and sensa- 
tions about the heart. 

2. In most cases of physical exhaustion, hysteria, 
hypochondriasis and in very many other conditions of ill 
health, the nervous system suffers more or less, and it is 
often shown by disturbed action of the heart, such as 
palpitation, irregular action, pain or discomfort about 
the heart. This class of cases is called by some physi- 
cians " nervous disorders of the heart." 

3. Distressing palpitation and other irregularities of 
the heart, are very often produced by indigestion, or 
dyspej:>sia, worms in the intestinal canal, constipation of 
the bowels, disease of the lungs, and various other 
causes reflex in their nature. Some of the most ob- 
stinate cases of palpitation of the heart the writer 
has ever seen, were owing to indigestion. Cases of 
chronic indigestion complicated by great irregularity of 
the heart, often j;>roduce great mental depression and 
anxiety regarding the health. Palpitation may be the 
result of over eating^ when the digestive and assimilative 
powers are good ; too much rich blood is made. The 
intemperate use of tobacco, and drinking strong coffee 
or tea are some times causes of disorders of the heart. 
These attacks come in paroxysms of greater or less 
severity and variable duration. Palpitation of the heart 



MISCELLANEOUS SUBJECTS. 439 

is not always complained of, but it usually is. If the 
heart's impulse is weak from any cause, the pulse stroke 
will be weak, and is usually much more rapid than 
natural, and may be irregular. A feeling of incapacity 
for jmysical and mental exertion exists; there are cold 
extremities, pallor of the face and a sensation of faint- 
ness and distress about the heart; despondency and a 
fear of dying is present in some instances. Dimness of 
vision, flashes of light, or other disturbances of the 
sight, the want of breath and cold shiverings are some- 
times present. Besides palpitation, which means an 
abnormally rapid and strong impulse of the heart, vari- 
ous other altered actions may be the prominent features; 
for instance, the heart may seem without ajiparent cause, 
to have a single strong impulse, as patients often express 
it, the heart seems to "turn over," which of course 
cannot happen. Again, there may be great irregularity 
in the force and frequency of successive beats, so that it 
is difficult to count the pulse; when the ear is placed 
over the heart to listen to its sounds, there seems to be, 
and there is, a tumultuous action of the heart. One of 
the most trustworthy signs of organic disease of the 
heart is what is called a murmur, which means an 
unnatural, or added heart sound; a murmur is some- 
times heard in a functional disease of the heart. 

From this brief account it may be learned that great 
disorder, and even pain and strange sensations about the 
heart, do not always indicate organic disease. 



^40 HANDBOOK. 



MEDICAL TERMS DEFINED. 

We explain a few of the more difficult medical words, 
that they may not be " all Greek" when they are 
heard in the learned talk of doctors, or when seen in 
print. Many of these words cannot be found in Web- 
ster's Unabridged Dictionary. 

ABSCESS: a collection of pus or purulent matter in any 
part of the body. 

ACUTE DISEASE : one more or less violent, and of short 
duration. 

ANAEMIA, a-ne'me-a: deficiency of the blood in quantity 
and quality, especially in red globules; poor blood. 

ANAESTHETICS, an-es-thet-ics: such medicines as chloro- 
form, ether, nitrous oxide gas, which destroy sensibility to 
pain. 

ANODYNE, an'o-dine: a medicine which allays pain. 

ANTHELMINTICS, an-thel-min'tics : destroyers of intes- 
tinal worms. 

ANTISEPTIC, an-ft-sep'tic: preventing- putrefaction. 

APHTHA, ap'tha: ulcers or canker in the mouth. 

APNCEA, ap-ne'a: without breath; difficult or impossible 
breathing. 

APOPLEXY, ap'o-plex-y: a stroke of palsy, often called a 
shock. 

ASCITES, a-si'tes: dropsy of the abdominal cavity. 

ASPHYXIA, as-fix'e-a: without pulse; suspended animation 
from strangulation, etc. 

ASTHENIA, as-the'ne-a: loss of strength. 

ATONIC: wanting natural strength. 

AUTOPSY, au'top-sy: a post mortem or after death examin- 
ation of the body. 

BACILLUS, ba-cil'us: one kind of bacteria. 
BACTERIA, bac-te'ria: microscopic germs; microbes. 
BRONCHIAL TUBES: those which lead to and through 
every part of the lungs. 



MEDICAL TERMS DEFINED. 



441 



BRONCHITIS, bronk-i'tis : inflammation, of the bronchial 
tubes. 

CEREBRO-SPINAL : referring to the brain and spine. 
CHLOROSIS : a disease peculiar to young females, attended 
with great pallor of the skin; green-sickness. 
COLON: the large intestine. 
COMA, cb'ma: deep stupor or lethargy. 
COMATOSE, com'a-tose: in a state of coma. 
CONGENITAL: born with, existing at birth. 
CONGESTION: unnatural supply of blood in a part. 
CONVALESCENT : improving in health. 
CORYZA, co-ry'za: a cold in the head; a watery discharge. 
CUTANEOUS : pertaining to the skin. 

DIAGNOSIS, dt-acj-no'sis: the art of knowing or discriminat- 
ing the disease and the result obtained. 

DIAPHORETIC, di-af-o-ret'ic: a medicine which produces 
sweating. 

DIURETICS, di-u-ret'ics : medicines which increase the 
urinary secretion. 

DYSPNOEA, disp-ne'a: difficult breathing. 

ECZEMA, ec'ze-ma: a very common skin disease; salt rheum 
is of this nature; catarrh of the skin. 

ENDEMIC, en-dem'ic: prevailing in particular localities. 

ENTERIC FEVER: typhoid fever. 

EPIDEMIC : prevailing among people. 

EPIDERMIS: the external skin, the cuticle. It is this 
which is raised in a blister. 

EPISTAXIS, ep-is-tax'is: nosebleed. 

EPIZOOTIC, ep-i-zo-ot'ic: a contagious disease prevailing 
among cattle and horses. 

ETIOLOGY, e-ti-ol' 'o-gy : the science of the causes of 
disease. 

EXPECTORANTS : medicines which facilitate raising mu- 
cus or phlegm from the bronchial tubes. 

FAUCES, faw'ces: the throat. 
FEBRILE, feb'rile: belonging to fever. 
FERRUM: iron. 
FISTULA: a pipe sore. 



442 



HANDBOOK. 



FLATULENCE: a collection of wind or gas in the bowels 
or stomach. 

FOMITES, fom'i-tes: a term applied to goods, clothing, 
etc., imbued with contagion. 

FUNCTIONAL DISEASE is one in which the action of an 
organ is vitiated, but its structure not changed; examples, 
dyspepsia and constipation. 

GASTRALGIA : pain in the stomach. 

GASTRIC: pertaining to the stomach. 

GASTRITIS: inflammation of the lining of the stomach; 
sometimes gastric fever. 

GERM THEORY OF DISEASE: the doctrine that teaches 
that diseases are caused by minute, microscopic germs, called 
bacteria, which arc on the border line between animals and 
plants. 

GERMICIDE: anything that destroys germs. 

HEMIPLEGIA, hem-i-ple'gi-a: paralysis of one side of the 
body. 

HEMOPTYSIS, Jicm-ojy'ti-sLs: bleeding from the lungs, 
spitting blood. 

HEMORRHAGE, ]ie)n'or-a<je: loss of blood: bleeding. 

HEMORRHOIDS, hem'or-oids: the piles. 

HYGIENE, M'gi-ene: the science and art of preserving 
health. 

HYPEREMIA, hi-per-e'nii-a: an over supply of blood in a 
part or organ. 

HYPNOTIC': having power to produce sleep. 

HYPODERMIC, hi-po-der'mic: under the skin. In late 
years, medicines are often injected under the skin by the use 
of a hypodermic syringe. 

IDIOSYNCRASY, id-i-o-syn'cra-sy: a peculiarity about an 
individual's constitution or temperament. 
INFLUENZA (epidemic) : la grippe. 
INSOMNIA: wakefulness or inability to sleep. 

LARYNGITIS, lar-in-gi-tis: inflammation of the larynx. 
LARYNX, lar'inx: the upper part of the windpipe. 
LESION, le-zhun: an injury or a diseased change of a part. 

MASSAGE, ma'sazh': the art of treating diseases by rubbing, 
kneading, and exercising the muscles, joints, etc. 



MEDICAL TERMS DEFINED. -143 

MATERIA MEDICA: a collective term comprising all sub- 
stances or medicines used in the treatment of diseases. 

MENINGES: the membranes (three) which surround the 
brain and spinal cord. 

MENINGITIS, men-in-gi'tis: inflammation of the meninges. 

MICROBE: a germ. 

MICROCOCCI, mic-ro-cocsi: minute creatures found in the 
sediment of water, supposed by some to be the same as 
bacteria. 

NARCOTICS: medicines which tend to produce sleep or 
stupor. 

OBSTETRICS, obstetrics: the science of midwifery, or as- 
sistance at childbirth. 

(EDEMA, e-de'ma: dropsy under the skin. 

ORGANIC DISEASES : those in which there is a real change 
in the substance or structure of an organ; opposed to func- 
tional diseases in this respect. 

PATHOLOGY: the knowledge or theory of disease. 

PERITONITIS: inflammation of the sac (peritoneum) of 
the bowels. 

PHARINGITIS, far-in-gi'tis: inflammation of the pharynx. 

PHARYNX, far'inx: the back part of the throat. 

PHTHISIS, ti'sis: consumption of the lungs. 

PLEURA; a membrane lining the chest. • 

PLEURISY : inflammation of the pleura. 

PROGNOSIS, prog-no'sis: a forecasting of the probable 
course and result of the disease. 

PTOMAINES, to'manes: poisonous substances resulting 
from putrefaction. 

PULMONARY: referring to the lungs. 

PUS: the creamy matter found in abscesses. 

PUSTULE: A pimple containing pus. 

P YJEMIA : pie'mi-a: pus in the blood, blood poisoning. 

QUINSY: acute inflammation of the tonsil ending in an 
abscess. 

f 
RABIES, ra'bi-es: the same as madness in the dog or oilier 
animal. 

RECTUM: the lower bowel. 



444 HANDBOOK. 

SANITARY: promoting health. 

SEDATIVES : medicines which have a soothing effect. 

SEPTIC : causing putrefaction. 

SEPTICAEMIA, sep-ti-se'mia: blood poisoning. 

SERUM: watery part of the blood. 

SUPPURATION: the formation of pus or matter. 

THERAPEUTICS : that branch of medicine which treats of 
the use of medicine to cure diseases. 

TONICS: medicines which give strength or tone to the 
system. 

TONSILLITIS : inflammation of the tonsils. 

TUBERCULOSIS: the formation of tubercles. 

VERTIGO: dizziness. 

VESICLE, ves'i-cle: a small water blister on the skin. 
VIRUS, vi'rus: poisonous matter produced by disease and 
capable of propagating disease ; vaccine matter. 



INDEX, 



Abscess, acute, 239. 

Acne, 313. 

Angina Pectoris, 208. 

Anaemia (poor blood), 293 

Antidotes, of poisoning, table of, 154. 

Antidotes in the kitchen, 53. 

Aphorisms, sayings on the diseases 

of children, 331. 
Apoplexy, 176. 

how it differs in symptoms from 
fainting, insensibility from 
drink, narcotic poisoning, sun- 
stroke, epileptic coma, hysteri- 
cal coma, etc., 178. 

treatment of apoplexy, 179. 
Appendix of the Caecum, 218. 
Asthma, 290. 

treatment, 291. 
Are diseases cured without medicine, 

27. 
Artificial respiration, 113. 

modes of performing in cases of 
drowning, lightning stroke, 
etc., 114. 
Bandaging, 105. 
Bilious Attacks, 277, 427. 
Biliousness, 427. 
Bites of Mad Dogs, 79. 

symptoms of madness, 80. 

treatment of bites, 82 
Bladder, inflammation of, 431. 
Boils, 242. 

Bowels, inflammation of, 219. 
Bronchitis, acute, 254, 371. 

table giving points of difference 
between bronchitis, pneumonia 
and pleurisy, 256. 

treatment of bronchitis, 256. 

capillary bronchitis, 254, 373. 
Bronchial Affections in Children, 371. 
Bright's Disease, chronic, 432. 
Brain, congestion of, 180. 

compression of, 92. 

concussion of, 91. 
Broken Bones or Fractures, 95. 

signs of, 95. 

treatment of, 96. 
Burns and Scalds, 109. 

treatment of, 109. 

precaution against, 111. 
Bullet Wounds , 76, 



Caecum, inflammation of, 218. 

symptoms of, 218. 

ulceration of appendix, 218. 
Carbuncle, 243. 
Catarrh, chronic nasal, 260. 
Catalepsy, 175. 
Cayenne pepper, its uses, 52. 
Chicken-pox, 396. 
Cholera Infantum, 356. 
Cholera Morbus, 214. 
Chorea (St. Vitus Dance), 413. 
Choking, 136. 
Chilblain, 132. 
Colic, intestinal, 212. 

in children, 346. 

bilious, 212. 

lead, 213. 

renal or kidney, 224. 

gall-stone, 222. 
Concussion of brain, 91. 
Congestion of brain, 180. 
Compression of brain, 92. 
Convulsions, 161. 

in children, 161, 366. 

partial, 370. 
Cold, taking, 244. 

how to break up a cold, 245. 

in the head, 247 
Colds and Coughs, 254. 
Constipation of the bowels, 281. 

in children, 359. 
Cough Mixtures, 257, 258. 
Croup, spasmodic, 378. 

treatment of, 380 

membranous, 380. 
Death, has it taken place, 127. 

signs and tests of, 128. 

signs of approaching, 26. 

modes of, 23. 
Delirium, 15. 
Diabetes, 433. 
Diarrhoea, simple, 284. 

in children, 352. 

inflammatory, 353, 357. 
Diphtheria, 397. 
Dislocations, 102. 

signs of, 102. 

of lower jaw, 102. 

of fingers and thumbs, 103. 

of shoulder, 103, 



446 



INDEX. 



Disorders of the stomach and intes- 
tines, 345. 
Dizziness (Vertigo), 182. 
Drowning, 116. 

treatment of, 117 

precautions against, 118. 
Dry Heat, its uses, 50. 
Dyspepsia, 270. 
Dysentery, acute, 286. 

treatment of, 287. 

in children, 358. 
Dying, modes of, 23. 
Earache, 196, 301. 

treatment of, 197. 
Ears, care of, 300. 

things in, 135. 

discharge from, 

in children, 226. 
Eczema, 309. 
Emetics, their uses, 50. 
Epilepsy, the Falling Sickness, 167. 
Epidemic Influenza, 263, 
Erythema, 320. 
Erysipelas, 321. 
Eyes, sore in children, 425. 

care of, 299. 

things in, 133. 
Fainting, 178. 
Face-ache, 199. 
Faith Cure, 28. 
Falling of the Bowels, 419. 
Fever, 18. 

symptoms and signs of, 18. 

treatment of, 20. 
Felon, 240. 
Fit of Gravel, 224. 
Fits and Spasms, 161. 

inward fits in children, 162. 

nine-day fits in infants, 162. 

child crowing, 163. 

table showing points of difference 
between epileptic and hysteri- 
cal fits, 169. 

epileptic, 167 

hysterical, 171. 

cataleptic, 175- 

apoplectic, 176. 
Fingers cut off, 72. 
Fish Hooks in the Flesh, 75. 
Foreign Bodies in Air Passages, 122. 



Fractures, 95. 

signs of, 95. 
Fracture at the Wrist, 97. 

treatment of, 98. 
Fracture of Collar Bone, 98. 

treatment of, 98. 
Fracture of Ribs, 99. 

treatment of, 99. 
Fracture of Hip, 100. 
Gastritis, inflammation of the stom- 
ach, 210. 
Gastralgia (neuralgia of the stomach) 

211. 
Gall-stones and gall-stone colic, 222. 
Headaches, 186. 

sick headache, 186. 

treatment of, 188. 

nervous headache, 191. 

treatment of, 192. 

bilious headache, 192. 

treatment of, 192. 
Heart Complaint, 436, 208. 

disorders which simulate it, 437. 

palpitation of the heart, 438. 

causes of, 438. 
Heat Stroke, 140. 
Heat, exhaustion from, 140 
Heat fever, 140. 
Hemorrhage from wounds, 61. 

how to stop it, 61. 

signs of dangerous loss of blood, 62 

different ways of stopping bleed- 
ing from arteries, 63. 

summary regarding the treatment 
of hemorrhage from wounds, 65. 
Hemorrhage from the lungs, 287. 
Herpes Zoster (Shingles), 328. 
Hernia, strangulated, 220. 
Hoarseness, 423, 248. 
Hot and cold water, 47. 

uses in medicine, 47. 
Humors, 307. 
Hydrophobia, 79. 

symptoms of, in the dog, 80. 

proper treatment of a dog sup- 
posed to be mad, 79. 

cases of spurious hydrophobia, 79. 

the prompt treatment of the bites 
of a mad dog, 82. 

the Pasteur treatment, 83. 



INDEX. 



447 



Hysterical convulsions or fits, 171. 

table showing the points of dif- 
ference between hysterical and 
epileptic convulsion or fits, 169 
Hysterical coma, 172. 

hysterical delirium, 173. 

treatment of hysterical convul- 
sions, 174. 
Ice, its uses in medicine, 49. 
Indigestion, acute, 277. 

chronic, 270. 

a fit of, 277. 

in infants, 346. 

in older children, 349. 
Incontinence of urine, (Bed-wetting), 

417. 
.Infancy and childhood, disease of, 331. 

aphorisms (sayings on,) 331. 

diseases of, 338. 
Injuries of the head, 91. 

from lightning stroke, 120. 

precautions against, 221. 

from severe cold, 130. 

from frost bites and frozen limbs, 
131. 

precautions against cold, 133. 

from the inhalation of gases, 124. 
Inflammation, 16. 

Insensibility from drink, narcotic 
poisons and other cases, 179. 

points of distinction, 180. 
Insomnia, (sleeplessness), 303. 
Itch, the, 325. 
Jaundice, 296. 

Kidney Complaints, 431, 226. 
Laryngitis, acute, 248. 
La Grippe, 263, 267. 

two forms, 264. 

treatment of, 266. 
Lichen, 328. 
Liver Spots, 329. 
Liver Complaint, 427. 
Lungs, hemorrhage from, 287. 
Lumbago, 229. 
Machinery Injuries, 88. 
Measles, 384. 

German, 393. 

table showing points of difference 
between measles and scarlet 
fever, 391, 395. 
Medicines in the house, 47. 



Medicine Case, 36. 

medicines for, 36. 

uses of, 37. 
Mosquito Bites, 86. 

treatment of, 87. 
Moth Spots, 329. 
Mumps, 406. 
Mustard, its uses, 45. 
Neck, glandular swellings of, 424. 

rheumatism of, 228. 
Needles in the flesh, 75. 
Neuralgia, 232. 

table showing points of difference 
between it and muscular rheu. 
matism, 229. 

intercostal, 203. 

in face, 199. 

sciatic, 235. 
Nettle Rash, 318. 
Night Terror in Children, 420. 
Nose bleed 'Epistaxis) , 288. 

things in, 136. 
Painful attacks, 186. 
Pain, 21. 

treatment of, 22. 

in bowels, 212. 

in chest, 201. 

in head, 186. 

in neck, 199. 

in stomach, 210. 

about the heart, 207, 208, 436- 
Palpitation of the heart, 183, 436. 
Patent medicines, 31. 
Peritonitis, 219. 
Pharyngitis, acute, 248. 
Pleurisy, acute, 201. 

in children, 376. 
Poisons and poisoning, 145. 

irritant poisons, 145. 

narcotic poisons, 146. 

symptoms of i/ritants, 147. 

symptoms of narcotics. 148. 

general treatment of poisoning, 147 

special treatment of poisoning 
148. 
Poisoning by opium, laudanum, rnor- 
phine,paregoric, soothing syrups 
and 1 other opiates, 148. 

by arsenic, 149. 

by strychnine, nux vomica, bella- 
donna and atropia, 150. 



448 



INDEX. 



Poisoning by oxalic acid, strong 
acids, tainted meats and fish, 
sausages and cheese, 152. 

by mushrooms, poisonous vege- 
tables, and alcohol, 153. 

by ice cream, 156. 

by the poison ivy, 157. 

by canned meats, 160. 

table giving antidotes for, 154. 

precautions against poisoning , 155 
Pneumonia, acute, 209, 243. 

in children, 375, 37G. 
Poultices, when useful, 48. 
Pruritus (itching skin disease), 323. 
Psoriasis (skin disease), 316. 
Pulse in health, 9. 

different kinds of pulse, 10 

its changes in disease, 11. 

the significance of the different 
kinds of pulse, 12. 
Quack Doctors, 34. 
Quinsy, 250. 
Railway Injuries, 89. 

precautions against, 89. 
Respiration or Breathing, 14. 
Rheumatism, muscular, 204, 228. 

table showing difference between 
rheumatism and neuralgia, 229, 

acute articular, 236. 

chronic articular, 237. 
Rickets, 415. 
Ringworms, 326. 
Rose Rash, 327. 

Rupture at the navel in infants, 421. 
Salt Rheum, 309. 
Scabies, 325. 
Scarlet Fever, 388. 

table showing points of difference 
between scarlet fever and 
measles, 391. 
Shock or collapse, 55. 
Shingles, the, 205. 
Skin, diseases of, 307. 
Skin Cancer, 329. 
Sleeplessness, 303. 
Small Pox, 407. 
Sore Throat, 248. 
Sore mouth in children, 338. 
Spasms, Fits and Convulsions, 161. 
Splinters and Thorns in the Flesh, 75, 



Sprains, 107. 

Spinal Irritation, 206. 

Stoppage of the Bowels, 216. 

Strangulation, 124 

St. Vitus Dance, 413. 

Styes, 425. 

Suspended Animation, 112. 

Sun Stroke, or Heat Stroke, 140, 178. 

symptoms of, 140. 
treatment of, 143. 

precautions against, 144. 
Sudden Attacks, 161. 
Syncope, 181. 
Teething (Dentition), 343. 
Teeth Knocked out, 139. 
Things in the Eye, 133. 
" " Ear, 135. 

" " Nose, 136. 

" Throat, 136. 
Things Swallowed, 137. 
The Itch, 325. 
Throat, sore, 422. 

things in, (choking), 136. 
Tongue, in disease, 13. 
Toothache, 193. 
Tonsillitis, acute, 250. 

follicular, 251. 
Transportation of the Injured, 58. 
Turpentine, Spirits of, its uses, 51. 
Urinary Disorders, 226, 431. 
Urticaria (Nettle Rash), 318. 
Vaccination, 409. 

methods of performing, 410. 
Vertigo, (Dizziness), 182. 
Wounds — Their Modern Treatment, 
67. 

antiseptic method, 68. 

two ways of healing, 67. 

treatment of, 71. 

punctured, 74. 

gun hot, 76. 

poisoned, 77. 

lacerated, 84. 

cut wounds of face, 73. 

wounds of scalp, 73,93. 
" " abdomen, 73. 
" " chest, 73. 
•< " throat, 73. 
Whooping Cough, 404, 
Worms, 361, 



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